PREFERRED QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associates or advanced degree.
EXPERIENCE:
1. Two (2) years’ experience in a health care setting.
2. Hospital, home health, or payer relations experience.
3. Clerical experience in utilization management, discharge planning or case management.
4. One (1) year of ICD9/CPT Coding or Medical Terminology experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Greets visitors and health care personnel promptly and professionally; screens visitors and telephone calls to determine urgency of contact and to facilitate appropriate routing or referral; representing Care Management in a positive manner.
2.Effectively communicates clinical information with payer to obtain authorization for post-acute services/medications and documents interactions in patient’s electronic medical record (EMR) along with timely communication with Care Management staff.
3. Participates in discharge planning activities (e.g. contact of post-acute care facilities, other community resources and transportation) as needed to ensure a timely patient discharge and appropriate linkage with post-acute providers
4. Provides prompt feedback regarding payer determinations to Supervisor/Care Manager, enabling them to evaluate/redirect the current patient plan of care in order to streamline the delivery of service.
5. Function as placement specialist, as required ,to include research for preferred providers for HHC/DME/Acute Rehab/SNF/LTACH placement
6. Proactively communicates any change in payer information to Supervisor/Care Manager and documents changes appropriately
7. Verify with patient financial counseling that all payment sources have been explored and updated in the patient’s electronic medical record (EMR).
8. Participates in reimbursement, certification and authorization related activities (e.g. faxing or copying required information) as required.
9. Contacts and coordinates with referral agencies to arrange provision of ordered equipment and associated services when appropriate, as directed by Care Managers.
10. Collects copies and transmits pertinent clinical and patient demographic information required to complete arrangements for post-discharge care and/or placement, as directed by the Care Managers.
11. Coordinates and arranges transportation and community services, as directed by care managers.
12. Provides secretarial and clerical support, including faxing, copying charts, filing, typing and scanning.
13. Ensures payer and customer satisfaction through effective communication and positive customer service skills at all times.
14. Maintains confidentiality of communications.
15. Using independent judgment prioritizes appropriately to ensure efficient utilization of time.
16. May serve as back up to the Administrative Assistant for Care Management in their absence.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Prolonged periods of standing or sitting.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Flexible hours to include weekends and holidays.
2. May include some patient interaction.

SKILLS AND ABILITIES:

1. Excellent verbal and written communication skills.
2. Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
3. Basic computer knowledge and ability to operate standard office software.