MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School diploma or equivalent

EXPERIENCE:

1. Two years additional training or related experienceOROneyear of secretarial training may substitute for experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate or advanced degree

2. LPN

EXPERIENCE:

1. Two years of experience in a health care setting

2. Hospital, home health, or payer relations experience.

3. Clerical experience in utilization management, discharge planning and case management

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 service/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 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 and long-term care placements.

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 update in the patient's EMR

8. Participates in reimbursement, certification, and authorization related activities (e.g., faxing or coping required information) as required.

9. Contacts and coordinates with referral agencies to arrange provision of ordered equipment and associated services with appropriate, as directed by Care Managers.

10. Prepares documents and transmits pertinent clinical and patient demographic information required to complete arrangement 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. Assists with uploading documents to assist Care Managers with all Medicare Appeal process.

13. Provides secretarial and clerical support, including faxing, coping EMR, filing, typing, and scanning.

14. Always ensures payer and customer satisfaction through effective communication and positive customer service skills.

15. Maintains confidentiality of communications.

16. Completes all authorizations for observation advance imaging, referrals to Swing within system and surgical add on cases.

17. Uses independent judgement to prioritize appropriately to ensure efficient utilization of time.

18. Will serve as back up to the Administrative Assistant for Care Management during any 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 standing or sitting may be required

2. Lifting supplies greater than 10 lbs.

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 meet the department needs

2. Some patient/community interaction

SKILLS AND ABILITIES:

1. Excellent telephone and reception skills

2. Computer knowledge, work with several different computer programs, and operate standard office software and devices (e.g., Navinet (BC program), Allscript (program for all CM work), fax, copier, and scanner)

3. Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.

4. Self-motivated with proven communication skills

5. Understanding of Medical terminology

6. Understanding of authorization process for radiology

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

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Cost Center:

Address: