Clinical Data Coordinator

SCOPE OF POSITION:

The Clinical Data Coordinator is responsible for the  organization and coordination of  data relating to clinical and administrative tasks. They are responsible for managing and using clinical information to provide clinical information to the payers, skilled nursing facilities, home care agencies and outpatient providers. The Clinical Data Coordinators maintains approvals, denials in a data electronic system which is reported out to senior leadership. Coordinates peer to peer with the physician advisor and manages the database of these outcomes.

RESPONSIBILITIES

·         Responsible for the data collection/entry, data management, departmental dashboard maintenance, and report preparation. 

·         Supports the Director of Case Management for high level utilization and compliance projects.

·         Functions as a Liaison between the Case Management, revenue cycle and the denial management team.

·         Assists the coordination of new employees by procuring compliance needs.

·         Reviews all denial letters from Payers and arranges peer to peers for Physician Advisor.

·         If peer to peer is unsuccessful collaborates with the revenue recovery coordinator to proceed with the denial.

·         Responsible for validating clinical information sent from case managers to appropriate payer. This is completed in a proactive manner to prevent denials.

·         Works on daily missing authorizations, ensuring the authorizations are captured for medical necessity by interacting with multiple individuals and multiple departments, thereby enhancing the speed of cash flow.

·         Compiles daily observation Admissions report for the Daily Monitor dashboard.

·         Responsible for the addition of the observation "billing charge" as determined after investigation of the front-end billing process, and the assurance of the accuracy of the report and its outcomes.

·         Responsible to release or add bill holds for all levels of clinical denials for inpatient level of care accounts.

·         Maintains the database for front-end overturned denials.

·         Responsible in placing action codes in Revenue Cycle to identify current state of denial inventory.

·         Attends weekly Revenue Cycle/Denial meetings as Case Management representation identifying current issues and contributes to development of best practices.

·         Assists in the improvement and direction of the "unbilled/denial" process.

·         Communicates with patient financial services department with write off forms to accept alternate level of care under the direction of the Physician Advisor. 

·         Maintain status log of all inpatient Medical Necessity insurance denials.

·         Maintains case management data systems and reports.  Responsible for revising; updating; determining and recommending system changes.  Takes an active role in assisting the management team in the development and implementation of new applications and system integration.

·         Maintains case management data in designated information systems.

·         Makes adjustments in Kronos for all staff in the department.

·         May perform other jobs related duties as requested or required.

REQUIREMENTS:

·         Associates degree preferred

·         2-3 years' experience as an Administrative Assistant and/or Financial Coordinator in a case management department.

·         Demonstrates an ability to perform financial activities associated with case management.

·         Possesses high level organizational skills.

·         Database information system experience preferred.

·         Fluent in MS Excel

·         Ability to communicate effectively with multiple levels of personnel/interdisciplinary teams with tact and confidentiality

·         Ability to work in a fast paced environment.

·         Must have strong knowledge of general database applications