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Job Description

Ensures that timely, accurate and complete data is submitted to appropriate insurance companies to guarantee prompt payments to Spectrum Health. Communicates and collaborates with the multidisciplinary team through verbal and written communication. Participates with Care Team for the integration of the patient to the home or transitional environment by developing, planning, implementing and evaluating in accordance with current existing federal, state and local standards. Adheres to confidentiality policies specific to communications, patient confidentiality, record keeping and coordination services.

• Inputs data from various sources (insurance companies, admissions, certification, and other hospitals) into Care Management discharge planning software and insures communication to members of Care Team.
• Processes and prepares clinical reviews completed by Care Management Department (CMD) employees for confidential transmission to third party payers.
• Maintains ongoing communication between Spectrum Health (SH) and third party payers related to the number of hospital days authorized, additional requests for clinical information, anticipated discharge needs, etc.
• Supports specific third party payers by obtaining authorization for services; providing accurate & timely admission/discharge dates; updating CMD and SH employees on any demographic changes; problem solving issues/concerns third party payer may have. Reports reviews needed to case manager.

• Required High School Diploma or equivalent
• Preferred Associate's Degree Business Administration, Management, Commerce, Communications, Public Relations or other related degree or equivalent combination of education and experience

• 2 years of relevant experience Related work in a clinical office or health insurance setting Required
• Working in an organization of size and complexity comparable to Spectrum Health Required

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Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member’s job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here.