Health First Careers

The Case Management Support Specialist facilitates discharge planning and insurance authorization by coordinating with patients, families, and third-party payers. They ensure accurate documentation of clinical information and regulatory forms to support reimbursement and efficient patient care transitions.

The UM Nurse performs medical necessity reviews to determine appropriate admission status and ensures compliance with regulatory and payer requirements. They collaborate with multidisciplinary teams to manage resource utilization, facilitate care progression, and handle denials and appeals.

Assign and sequence accurate ICD 10 and CPT 4 codes for various outpatient records while ensuring regulatory compliance. Validate computer-assisted coding and collaborate with providers to clarify ambiguous clinical documentation for revenue enhancement.

Assign and sequence accurate ICD-10 codes for inpatient medical records to ensure regulatory compliance and revenue enhancement. Collaborate with providers and Clinical Documentation Specialists to clarify health record information and optimize DRG assignments.