Clinical Referral Coordinator (LPN) (10734)

Responsibilities

• Receive, review, and monitor new referrals to determine ability to accept or decline.
• Accurately determine and anticipate homecare needs and accept or decline on clinical appropriateness and our company’s Acceptance to Service Policy.
• Assists in interpreting operational indicators to detect census changes and increases or decreases in volume, which could impact staffing levels, revenues, or expenses.
• Collaborate with multiple teams, both internal and external, to ensure patient success in the homecare setting.
• Demonstrate professional assertiveness when communicating with external referral resources.
• Report and/or troubleshoot missing or incomplete documentation or visit notes needed for new admissions.
• Works with Authorizations and clinical management team when new insurances are identified to determine reimbursement, ability to bill, and if new contract is needed.
• Call for, follow up on, track, and obtain verbal orders for admissions.
• Fax written orders for signature for admissions when verbal order unable to be obtained.
• Ability to track, trend, and maintain accept/decline reports.
• Ability to identify primary and secondary billable diagnosis.
• Understand and adhere to F2F requirement regulated by CMS.
• Ability to maintain Pre-Claim Review (PCR) of no less than 97% (While participating in PCR as an agency).
• Utilize office and other patient care software, including Microsoft Word, Excel, Adobe, and E-Fax.
• Maintain confidentiality of information related to patient and organization.
• Perform interdepartmental and external communication.
• Engage in team meetings and provide feedback.
• Develop and implement organization policies and procedures under guidance of supervisor(s).
• Attend in-person training and meetings when necessary.

Qualifications

• Active Multi-State LPN License.
• 2 years' experience in healthcare data entry or customer service preferred.
• Ability to work independently or as an active member of a team.
• Strong computer skills in data entry, Microsoft Excel, and Word applications, must type 50 WPM.
• Strong attention to detail, problem-solving, time management, verbal and written communication skills.
• Able to navigate multiple EMR systems (EPIC, Alis, Kinnser) for patient information with ease.
• Ability to multitask, prioritize, delegate, and handle constant changes in workflow.