Computer System Validation Manager Jobs in Delaware

Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values ofLoveandExcellenceand are passionate about delivering health, not just health care. Come join us at ChristianaCare!

Our Utilization Management departmentlocated in Wilmington, DE is looking for a full-timeAdministrative Assistant IIto support the Utilization Management Denials and Appeals team. Work closely with RN Appeals Management Nurse and Physician Advisors to optimize appeals for denied Inpatient hospitalizations via administrative assistant supporting including but not limited to, scheduling, data entry, form completion, mailing, creating appeals packet, contacting insurance companies and working closely with other departments in revenue cycle. Prior claims knowledge is essential.

The ideal candidate will be well organized, detail oriented and can multitask. Candidate to complete tasks and duties within a prescribed timeline. Strong computer skills as well as good verbal and written communication skills.

• Generous PTO, Competitive Pay & Robust Benefits Package.
• 403B company match and Tuition Reimbursement
• 12 weeks Paid Parental Leave (after one year of service)

The responsibilities will include;

• Scheduling phone calls and meetings for members of the appeals team with payer representatives
• Establishes collaborative relationships with Physician Advisors/ Admitting/Utilization Managers/Clinical Documentation Improvement Specialist / Care Managers/ Billing and other health care staff to effectively and efficiently complete appeals.
• Enters accurate data, authorization/referral entries into computer system timely
• Calls insurance companies for authorization, benefit verification, denial and appeals information, as requested.
• Provides superior customer service to providers and members.
• Acquires new skills needed for performing job functions as the healthcare/delivery system changes.
• Participates as an active member of the team, offering suggestions and recommendations for more effective and efficient operations.
• Assists in contacting patient and families to discuss appeal options, status, and outcome, as requested
• Demonstrate ability to identify and define issues of concern, collect, and analyze data, establish facts, draw valid conclusions, and exercise discretion and sound judgment.
• Maintains confidentiality of patient information.
• Participates in seminars/workshops and in-service education regarding new resources, as requested.
• Provides administrative support to the team; assists with copying, faxing, form completion, addressing emails and Medicare letters by department standards.
• Assists with completion of Utilization Management duties including providing clinical information to insurance companies to obtain authorizations and updating patient records timely.
• Assist in scheduling phone calls and meetings for members of the UM team with payer representatives.
• Take lead on contacting insurance companies pending payor determinations for appeals.
• Take lead on contacting insurance companies to resolve administrative denials in real time when possible, to avoid written appeals.
• Establish a knowledge base for medical necessity requirements for all major insurance companies for inpatient authorization approval.
• Establish a knowledge base for administrative requirements for all major insurance companies for inpatient authorization approval.
• Assists with general support services and office coverage as staffing needs dictate.
• Establishes collaborative relationships with Utilization Managers, Care Managers and other health care staff to effectively and efficiently complete necessary services.
• Enters accurate data, authorization/referral entries into computer system as directed by team in an accurate and timely manner.
• Calls insurance companies for authorization, benefit verification and coverage information as necessary.
• Execute proper use of the telephone and voice mail systems. Incorporates services standards for telephone contact into daily activities
• Communicates effectively with departments in the Christiana Care Health System.
• Performs specific projects as directed by Supervisor and/or Director.
• Acquires new skills needed for performing job functions as the healthcare/delivery system changes.
• Participates as an active member of the team, offering suggestions and recommendations for more effective and efficient operations.
• Maintains confidentiality of patient information.

Proficient with Microsoft Word, Excel, and PowerPoint

Proficient computer skills.

Ability to function as a member of an interdisciplinary team. Ability to learn and understand basic medical terminology.

Ability to organize and prioritize work assignments.

Understand HIPPA/Privacy regulations with patient medical records

Knowledge of PC including EMR applications including power chart.

Typing skills are mandatory.

Strong organization and superior communication skills are required.

Knowledge of telephone communication skills.

Knowledge of the insurance authorization process is preferred.

Qualifications:

• High School diploma or equivalent required
• Four years progressively responsible administrative support to an administrator or manager
• Experience in a support role in Hospital Billing, Revenue Integrity, Utilization Management preferred

• Intermittent sitting, standing, and lifting. Capable of getting from and to nursing units and other areas of the facilities as required.

• Occasional contacts with patients who have a communicable disease or who may behave violently. Hospital office space.

ChristianaCare was recognized as one of "America's 100 Best Hospitals" by Healthgrades, selected as one of the Most Wired Hospitals in the US by the American Hospital Association, and ranked by US News & World Report as the #3 'Best Hospital' in the Philadelphia region out of more than 90 hospitals. To learn more click on this linkhttps://www.youtube.com/watch?v=AZtpU0ib3t8

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

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EEO Posting Statement

ChristianaCare offers a competitive suite of employee benefits to maximize the wellness of you and your family, including health insurance, paid time off, retirement, an employee assistance program. To learn more about our benefits for eligible positions visithttps://careers.christianacare.org/benefits-compensation/