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Case Manager

Case Manager
Atlanta, GA, United States
Job ID : R0008853
Job ID : R0008853

City: Atlanta

State: GA

Zip: 30328

Case Manager:


Job summary:

Provide a high level of individual patient management that encompasses comprehensive insurance
verification, authorization, adherence to contract guidelines and negotiation of profitable rates with noncontract
payers. Maintain a level of accountability and consistency with cases.


Activities:
 Verify member eligibility and benefits with health insurance companies
 Obtain all necessary medical records from Aveanna Locations and submit the information to the health
plan Case Manager to initiate the authorization process for nursing services and obtain
authorization or denial of services.
 Seek clarification on benefits not clearly stated in benefit plan with lead representative or
supervisor.
 Coordinate with member families and Aveanna Locations to ensure maximum benefits are available to
Aveanna patients
 Negotiate rates for home health services when no contract applies
 Maintain open communications with the Aveanna Locations on the status of obtaining authorization for
home health services.
 Maintain open communications with the health plan case manager
 Build and maintain payor relationships
 Identify and adhere to payor specific requirements
 Setup new patients in the Aveanna billing system
 Communicate to Aveanna Locations the outcome of the request for authorization for services and
patient benefits
 Coordinate with Aveanna’s Third Party Liability team to manage coordination of benefits
 Provide assistance to AR department as needed to help with high dollar claims issues.


Qualifications:
 College Degree or equivalent experience
 Minimum five (5) year prior Home Health Care experience
 Minimum five (5) year prior experience in verifying eligibility and benefits for Home Health Services
 Excellent oral and written communication skills
 Ability to organize and prioritize responsibilities
 Experience in Excel and Microsoft Word
 Excellent interpersonal skills
 Must demonstrate a positive attitude in a team environment


Physical Requirements:
1. Must be able to perform movements that regularly require repetitive use of the wrist(s), hand(s) and
or finger(s) approximately 80-90% of the workday
2. Finger dexterity to perform typing, picking up small objects, etc. approximately 80-90% of workday.
3. Must be able to verbally communicate instructions or other information as required approximately
80-90% of workday.
4. Must have adequate visual abilities to prepare, inspect documents or operate office machinery
approximately 100% of workday.
5. Must be able to exert physical strength and occasionally lift up to 25 pounds and/or frequently up to
15 pounds.
6. Must be able to hear average or normal tone conversations and understand/interpret noises or
spoken information.
7. Must be able to safely and properly drive vehicles.
8. Must be able to bend, turn/twist, kneel, squat 30-40% of each workday.
 

#Aveanna

Requisition ID: R0008853

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