At UK King's Daughters, we're not just a healthcare facility — we're a family of dedicated professionals who share a passion for making a meaningful difference in the lives of our patients. We're more than just a place to work; we're a place to grow, thrive, and contribute to our community.

Job Description :

Job Summary Responsible for providing clerical and administrative support to the case management department to prevent and manage denials. Researches and updates payer requirements to ensure compliance. Follows up on pending authorizations and appeals to facilitate timely resolution. Maintains accurate documentation and supports departmental workflow. Ensures effective communication with internal teams and external payers. Essential Functions

• Processes incoming mail related to utilization management.
• Communicates denial information to the revenue integrity department.
• Submits appeals for technical denials and supports case managers in appeal cases.
• Researches and confirms payer requirements, educating the case management team and updating shared resources.
• Maintains all payer portals.
• Acts as a liaison for the business office, payers, and onsite nurses regarding claim issues.
• Calculates Medicare Days for patients to support authorization requests.
• Manages payroll and department schedules.
• Performs other duties as assigned.

Education Requirement High school diploma or equivalent experience Experience Requirement 0-2 years of experience in a healthcare, clinical setting, or a relevant area An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field. Part-time and PRN experience will be prorated based on hours worked per week. Volunteer work and internships for academic credit are not counted. Certifications & Licensures N/A Working Conditions A. Lifting, pushing, and/or pulling objects up to 50lbs: 2. Occasional ( 50% of the time) F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials: 2. Occasional ( 50% of the time) H. Working at heights above 4 feet: 1. Never I.

Working in confined spaces:

1. Never J. Risk of injuries from use of equipment on the job: 2. Occasional (< 10% of the time) K.

Job-related travel:

2. Occasional (< 10% of the time) L.

Loud noises:

1. Never M.

Temperature extremes:

1. Never N. Hazardous chemicals and fumes including waste: 1. Never O.

Radiation:

1. Never P.

Burns:

1. Never Q.

Cuts/Punctures:

2. Occasional (< 10% of the time) R.

Bloodborne/airborne pathogens:

1. Never S.

Recombinant DNA or viral vectors:

1. Never T.

Combative/violent people:

1. Never U. Animal handling (including carcasses): 1. Never V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A Physical Demands This position requires regular sitting at a computer workstation for extended periods of time; regular performance of tasks with repetitive motions (such as typing or data entry); intermittent standing or walking with objects weighing up to 10 pounds; occasional standing or walking with objects weighing up to 25 pounds; and occasional lifting, pushing, and/or pulling of objects weighing up to 50 pounds. Also involves occasional risk of back injury from moving, lifting, or positioning equipment or materials; occasional risk of injuries from use of equipment on the job; and occasional exposure to cuts or punctures. Occasional job-related travel may also be required.

Additional Job Descriptions N/A Department :

Case Management Shift :

Days (United States of America)

Time Type :

Full time

Address :

2201

Lexington Avenue City, State :

Ashland, Kentucky