Heritage Provider Network

Compensation

Full Description

Rotational WorkSchedule: 5-8-hour shifts / Weekends: Two weekends a month 6AM-3PM Under the direction of the UR Administrative Supervisor, this position is responsible to serve as a liaison between the hospitals and the Inpatient case management team to identify and track all inpatient admissions, observations, skilled nursing facility and emergency room visits for our assigned members. The Case Coordinator will also assist with the concurrent review process of all inpatient admissions by way of timely documentation and communication of level of care changes throughout the inpatient stay, including coordinating post hospital discharge needs based on task assignment. The Case Coordinator will be required to interact with other departments, clinic personnel, and outside providers/facilities in a timely and professional manner, to create and foster positive relationships. • Must be familiar with verifying eligibility and health plan benefits specific to inpatient and skilled nursing facility admissions. • Track and confirm new patient admissions and discharges from hospital and skilled nursing facility. • Generate inpatient, observation and skilled nursing facility case authorizations accurately and within regulatory timeliness standards. • Notify hospitals and facilities of case determinations within regulatory standards. • Track and log hospital admission level of care changes as documented by Case Managers daily. • Produce daily hospital, skilled, nursing facility and case management census no later than 9:30am daily. • Perform daily responsibilities as a team to ensure accuracy and completion of tasks within a timely manner. • Ensure hospitalists and case manager assignments are updated and distributed to the team within designated departmental timeframes. • Communicate directly with hospitals, case managers, support staff and supervisors to ensure daily hospital census' are current and accurate. • Review related case authorizations auditing reports weekly to confirm accuracy. • Review census auditing reporting daily to ensure admissions are accurately captured in system. • Research and identify admissions as out of area per definition of health plan and DOFR and refer to health plan accordingly. • Research and compile information with regard to claims requests for reviews and appeal and forward to appropriate individual for completion of review and determination of request. • Document and process claims reviews based on final determinations. • Receive and process incoming phone calls, fax and emails and respond in a timely manner. • Responsible for generating authorizations to appropriate providers with accurate CPT, HCPC and ICD-10 coding in accordance with post hospital discharge orders, departmental and regulatory timeliness standards. • Maintain filing and documenting into departmental systems in a timely manner. • Responsible for adhering to departmental, CMS and health plan requirements in relation to generating authorizations, cases and notification of determinations within regulatory requirements. • Maintain patient confidentiality within HIPAA regulations. • Inform supervisor on a daily basis when problems arise, delays in completing assignments or work falls behind. • Communicate in a positive, helpful, polite, respectful and professional manner with fellow staff and outside vendors. • Cultural and Linguistics training is required annually. • Other duties as assigned. • May be required to work weekends and/or overtime, as assigned. • High School diploma or GED certification, required. • Two -years minimum experience working in a medical office setting or managed care organization, required. • Proficient in computer skills including working knowledge of Excel and Word programs, required. • Knowledge of Medical Terminology, required. • Knowledge of CPT, HCPC and ICD-10 Coding. • Typing Certificate of 40 wpm, required • Proficient written and oral communication skills • Excellent organization and time management skills. The pay range for this position at commencement of employment is expected to be reasonably between $25.50 - $28.55. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.