Medical Biller

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MUST HAVE C2 ENGLISH NO ACCENT

9-5 EST


Job Description
We are seeking an experienced Remote Case Manager with expertise in concurrent reviews and care coordination for nursing home patients. This role requires a clinical background, proficiency in PointClickCare software, and familiarity with insurance coordination platforms like Availity, Nava Health, and Navanet.
Key Responsibilities
Conduct concurrent reviews for nursing home patients, ensuring compliance with insurance requirements and advocating for additional time when necessary.
Coordinate seamlessly with clinical staff (nurses, physicians, therapists) and insurance providers to align care plans with coverage policies.
Utilize PointClickCare for real-time documentation, care plan updates, and communication with interdisciplinary teams.
Manage insurance authorizations, claims, and appeals through Availity, Nava Health, and Navanet platforms.
Perform clinical assessments to justify extended stays or additional services during concurrent reviews.
Maintain accurate records and ensure compliance with Medicare/Medicaid guidelines and organizational policies.
Qualifications
Required:
3+ years of case management experience in nursing homes or post-acute care.
Proficiency in PointClickCare and Availity (claims processing, eligibility verification, prior authorization).
Strong understanding of concurrent review processes and insurance workflows.
Preferred:
Experience with Nava Health and Navanet software.