Case Manager

• Review referrals and supporting documentation for completeness and accuracy.
• Verify patient demographic and insurance information.
• Review orders, diagnoses, clinical notes, labs, diagnostic testing, and other supporting documentation needed for the authorization process.
• Communicate with referring clinics to obtain missing or additional documentation. Maintain accurate case statuses and follow-up dates throughout the referral process.
  Maintain accurate case statuses and follow-up dates throughout the referral process.

• Verify insurance eligibility and benefits.
• Initiate prior authorizations or predeterminations according to payer requirements.
• Complete available portions of authorization paperwork using documentation provided by referring clinics.
• Submit completed authorization packages and supporting documentation to insurance companies.
• Monitor pending authorizations and follow up promptly with payers and clinics. Maintain accurate authorization documentation within Reliant systems.
  Maintain accurate authorization documentation within Reliant systems.

• Coordinate follow-up when an authorization is denied.
• Communicate denial information and available next steps with referring clinics.
• Obtain documentation needed to support appeals.
• Coordinate appeal documentation with the appropriate Reliant clinical team and referring provider.
• Submit appeal documentation to insurance carriers and monitor the case through resolution.
• Manage ongoing reauthorizations for established patients.

• Research manufacturer copay programs and nonprofit financial-assistance options when applicable.
• Maintain required financial-assistance information and documentation.
• Communicate with patients regarding approval and estimated out-of-pocket responsibility as applicable.
• Help move approved patients through the appropriate scheduling or shipment workflow.

• Serve as a point of communication between patients, referring clinics, insurance companies, billing, and internal Reliant departments.
• Document case activity, contacts, authorization progress, and outcomes in required Reliant systems.
• Provide timely status updates and maintain appropriate follow-up throughout the authorization process.
• Work collaboratively with internal teams to support accurate billing documentation and efficient patient access to therapy.

• Is highly organized and able to manage multiple patient cases and follow-up deadlines.
• Has strong attention to detail, particularly when reviewing insurance and clinical documentation.
• Communicates professionally and confidently with patients, physician offices, insurance companies, and coworkers.
• Is comfortable working through detailed insurance and authorization processes.
• Can recognize missing information and proactively work with the appropriate parties to resolve barriers.
• Demonstrates sound judgment, accountability, follow-through, and a patient-focused approach.
• Works effectively in a fast-paced, collaborative healthcare environment.

Benefits

• Medical, Dental, and Vision Insurance
• 401(k) with Company Match (up to 4%)
• Paid Time Off
• Supportive and collaborative work environment
• Opportunity to grow with a rapidly expanding healthcare organization

Equal Opportunity Employer

Reliant Healthcare is proud to be an Equal Opportunity Employer. We are committed to providing equal employment opportunities to all applicants and employees without regard to any characteristic protected by applicable federal, state, or local law.