Care Coordination Specialist

Responsibilities

• Utilization Management
• Payer communications - responds to requests and inquiries and provides information as requested.
• Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process.
• Provides patients with the IM Letter from Medicare prior to discharge.
• 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. If the authorization/precert information is missing or incorrect, contacts admitting to obtain the necessary and accurate information.
• Daily log reconciliation.
• Utilizes Information System to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process.
• Retrieves information for the Physician Advisors as needed.
• Works the DNFB report to determine outlier days, approved days, etc., and releases accounts as appropriate.
• Verifies admission and discharge date information. Updates Utilization Review RN needed for payors.
• Enters all documentation into EPIC/Applicable IT system for denials/ lower level of cares.
• Insurance Authorizations
• Contact insurance companies for benefit coverage and obtains authorizations when needed.
• SAR Ambulance Transport Post - Acute Care Referral Management
• 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.
• Obtains necessary supportive information from the medical record.
• Manages Referral Documentation.
• Appointment Scheduling
• Arrange Medicaid appointments.
• Arrange follow up appointments at MD's office and/ or clinics.
• Other duties and/or projects as assigned.

Qualifications

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
• Experience in the healthcare industry.
• Effective written, oral, and interpersonal communications skills.
• Proficient computer, word-processing and Excel spreadsheet skills.
• Ability to learn new computer systems, i.e.: EPIC, INDICIA.
• Educated in the unique clinical and discharge needs of the patients.
• Strong time management and priority-setting skills.
• Ability to work independently and as a team member.
• Self-directed with the ability to take the initiative to solve problems.