Case Management Assistant

Job Function:

CMA:

Case Management Assistants function in a support role to the Telephonic Case Manager.  Incumbents to this role are responsible for logging into the telephone queue for incoming calls related to case management; accurately inputting demographic information for new files received via fax, email, or another method other than EDI; downloading new files from the FROI tool in Ahshay; making initial calls to the provider and/or claimant on new referrals to determine the need for case management; assigning the claim to a nurse for case management; and assisting with administrative functions throughout the life of a claim, as assigned by the Telephonic Case Manager.

Job Components:

• Presents a courteous, helpful, professional manner to all callers.

• Adheres to Customer Special Account Instructions to include documentation requirements and specific turn around times.

• Demonstrates effective time management skills by entering and processing the number of reviews/files/faxes consistent with departmental policies.

• Communicates to supervisor when it appears that communications will not be completed within specific time frames or for other issues, cases that require supervisory advice/decisions.

• Adheres to all appropriate privacy, security, and confidentiality policies and procedures.

• Actively participates as a contributing team member as demonstrated by attitude, cooperation, shared problem solving and participation in projects.

Job Duties:

General Duties:

• Researches claim in system and/or FROI tool prior to manually entering claim.

• Manually enters claim as necessary.

• Logs into the appropriate telephone queue and meets TCM/UR telephone standards.

• Responds to callers’ requests and queries.

• Other duties as assigned.

Additional Duties:  specific per position:

• Contacts the provider and/or claimant to obtain the medical and work status of the claimant on new referrals; and determines the need for case management.

• Accurately enters and/or updates demographic information in Ahshay for all contacts (i.e., claimant, employer, provider, facility, claim handler) as information is obtained during initial calls.

• Accurately enters treatment request data, ICD9 and CPT codes

• Accurately enters work status data and ICD9 codes into a Disability Management window

• Accurately enters guidelines if diagnosis obtained.

• Assigns claim to the appropriate Case Manager, based on established criteria, within four hours of receipt of the referral.

• Assists Telephonic Case Managers with administrative duties throughout the life of a file, as assigned by the Case Manager.

• Maintains activity board for daily work, and works within team to check assigned boards and reassign cases as needed during planned and unplanned staff absences.

Requisite Skills:

• Excellent verbal and telephone communication skills

• Excellent customer service skills in a high demand telephonic business environment

• Proficiency with word processing/computer software systems

• Typing proficiency at a minimum of 30 WPM

• Ability to work independently

• Ability to prioritize and organize work

• Ability to handle multiple tasks

• Strong problem solving skills

• ​Attention to detail/accuracy and a commitment to excellence is mandatory

Qualifications:

• High school diploma or equivalent

• Completion of 15 months of employment

• Successful Completion of Career Ladder Level 1

Acrisure is committed to employing a diverse workforce. All applicants will be considered for employment without attention to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran, or disability status.  California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at www.Acrisure.com/privacy/caapplicant.
 

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