Case Manager

Responsibilities

• Investigate and resolve complex insurance coverage issues for patients in Skilled Nursing Facilities
• Negotiate and establish direct billing agreements with facilities
• Verify insurance eligibility and resolve coverage disputes with payers, Medicaid, and managed care plans
• Manage insurance denials and appeals related to SNF stays
• Maintain accurate documentation of account activity and outreach in compliance with HIPAA and CMS guidelines
• Collaborate with billing, clinical staff, and social workers to resolve coverage gaps

Requirements

• High school diploma or equivalent
• Minimum 2 years of experience in medical billing, insurance verification, or case management
• Working knowledge of Medicare Part A and Part B coverage rules
• Experience resolving insurance coverage gaps or unspecified payer accounts
• Strong communication and negotiation skills
• Ability to manage a high volume of accounts independently

Preferred Qualifications

• Experience in billing, credentialing, or revenue cycle environments
• Knowledge of Medicaid billing and managed care processes
• Certified Case Manager (CCM) or utilization review experience
• Proficiency with EHR systems like Epic, Cerner, or PointClickCare

Benefits

• $25-29 per hour plus quarterly bonus
• Health, Dental, and Vision Insurance
• Generous 401K plan
• Paid time off and holidays
• Life Insurance
• Education stipend

About the Company

Skilled Wound Care is a Great Place to Work® Certified company, recognized for its positive employee experience. Part of the Skilled Physicians Group, the organization focuses on specialized care and excellence in clinical outcomes.