Care Coordination Specialist - Full Time - Day
Overview:
Our team members are the heart of what makes us better.
At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed.
With a culture rooted in connection and collaboration, our employees are team members.
Here, competitive benefits are just the beginning.
Its also about how we support one another and how we show up for our community.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The Care Coordination Specialist performs selected services and functions related Transitions of Care & Utilization Management, including insurance authorization, payer communications, Appeals and Denial information, and scheduling.
Responsibilities:
Utilization Management 1.
Payer communications - responds to requests and inquiries and provides information as requested.
2.
Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process.
3.
Providing patients with the IM Letter from Medicare prior to discharge.
4.
In collaboration with the Care Coordinator, reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed.
Alerts the CC to potential problems with any of the above.
5.
If the authorization/precert information is missing or incorrect, the Specialist will contact admitting to obtain the necessary and accurate information.
6.
Daily log reconciliation.
7.
Utilizes Information System to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process.
8.
Retrieves information for the Physician Advisors as needed.
9.
Works the DNFB report to determine outlier days, approved days, etc.
, and releases accounts as appropriate.
10.
Verifies admission and discharge date information.
11.
Updates Utilization Review RN needed for payors.
12.
Enters all documentation into EPIC/Applicable IT system for denials/ lower level of cares.
Insurance Authorizations 1.
Contacts insurance companies for benefit coverage and obtains authorizations when needed.
2.
SAR 3.
Ambulance Transport PostAcute Care Referral Management 1.
Manages Referrals to external facilities & services including but not limited to the following:
Assisted Living Facilities, Acute Rehab, Subacute Rehab - New referrals & Returns, LTAC, Hemodialysis - New & Returns, DME, Hospice, Palliative Care, Wound Care, Home Health Services, Community Resources.
2.
Obtains necessary supportive information from the medical record.
3.
Manages Referral Documentation.
Appointment Scheduling 1.
Arrange Medicaid appointments.
2.
Arrange follow up appointments at MD's office and/ or clinics.
Additional Duties 1.
Fax medications, once received from CC to a particular pharmacy.
2.
Fax EARC or PASSR to State of NJ Offices.
3.
Fax applications for Medication assistance.
4.
Other duties and/or projects as assigned.
5.
Adheres to HMH Organizational competencies and standards of behavior.
Qualifications:
Education, Knowledge, Skills and Abilities Required:
1.
High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
2.
Experience in the healthcare industry.
3.
Effective written, oral, and interpersonal communications skills.
4.
Proficient computer, word-processing and Excel spreadsheet skills.
5.
Ability to learn new computer systems, i.
e.
:
EPIC, INDICIA.
6.
Educated in the unique clinical and discharge needs of the patients.
7.
Strong time management and priority-setting skills.
8.
Ability to work independently and as a team member.
9.
Self-directed with the ability to take the initiative to solve problems.
Education, Knowledge, Skills and Abilities Preferred:
1.
A minimum of 3 years recent experience in a hospital or medical setting.
Recommended Skills Assisted Living Care Coordination Case Management Clinical Works Communication Curiosity Estimated Salary: $20 to $28 per hour based on qualifications.
Our team members are the heart of what makes us better.
At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed.
With a culture rooted in connection and collaboration, our employees are team members.
Here, competitive benefits are just the beginning.
Its also about how we support one another and how we show up for our community.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The Care Coordination Specialist performs selected services and functions related Transitions of Care & Utilization Management, including insurance authorization, payer communications, Appeals and Denial information, and scheduling.
Responsibilities:
Utilization Management 1.
Payer communications - responds to requests and inquiries and provides information as requested.
2.
Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process.
3.
Providing patients with the IM Letter from Medicare prior to discharge.
4.
In collaboration with the Care Coordinator, reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed.
Alerts the CC to potential problems with any of the above.
5.
If the authorization/precert information is missing or incorrect, the Specialist will contact admitting to obtain the necessary and accurate information.
6.
Daily log reconciliation.
7.
Utilizes Information System to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process.
8.
Retrieves information for the Physician Advisors as needed.
9.
Works the DNFB report to determine outlier days, approved days, etc.
, and releases accounts as appropriate.
10.
Verifies admission and discharge date information.
11.
Updates Utilization Review RN needed for payors.
12.
Enters all documentation into EPIC/Applicable IT system for denials/ lower level of cares.
Insurance Authorizations 1.
Contacts insurance companies for benefit coverage and obtains authorizations when needed.
2.
SAR 3.
Ambulance Transport PostAcute Care Referral Management 1.
Manages Referrals to external facilities & services including but not limited to the following:
Assisted Living Facilities, Acute Rehab, Subacute Rehab - New referrals & Returns, LTAC, Hemodialysis - New & Returns, DME, Hospice, Palliative Care, Wound Care, Home Health Services, Community Resources.
2.
Obtains necessary supportive information from the medical record.
3.
Manages Referral Documentation.
Appointment Scheduling 1.
Arrange Medicaid appointments.
2.
Arrange follow up appointments at MD's office and/ or clinics.
Additional Duties 1.
Fax medications, once received from CC to a particular pharmacy.
2.
Fax EARC or PASSR to State of NJ Offices.
3.
Fax applications for Medication assistance.
4.
Other duties and/or projects as assigned.
5.
Adheres to HMH Organizational competencies and standards of behavior.
Qualifications:
Education, Knowledge, Skills and Abilities Required:
1.
High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
2.
Experience in the healthcare industry.
3.
Effective written, oral, and interpersonal communications skills.
4.
Proficient computer, word-processing and Excel spreadsheet skills.
5.
Ability to learn new computer systems, i.
e.
:
EPIC, INDICIA.
6.
Educated in the unique clinical and discharge needs of the patients.
7.
Strong time management and priority-setting skills.
8.
Ability to work independently and as a team member.
9.
Self-directed with the ability to take the initiative to solve problems.
Education, Knowledge, Skills and Abilities Preferred:
1.
A minimum of 3 years recent experience in a hospital or medical setting.
Recommended Skills Assisted Living Care Coordination Case Management Clinical Works Communication Curiosity Estimated Salary: $20 to $28 per hour based on qualifications.
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