Job Description

Job Description

Providence Health

Founded as Providence Hospitals in 1938 by the Sisters of Charity of St. Augustine, Providence's two free standing full-service hospitals and numerous satellite practices maintain a true devotion to advanced clinical expertise and unmatched compassion. On February 2, 2016, Providence became part of the LifePoint Health network, and shortly thereafter, changed its name to Providence Health to better represent the full complement of its services. Driven by quality, compassion, and Christ, Providence treats the whole person- body, mind, and spirit.

Providence Health is currently looking for an experienced Case Management Assistant for our Emergency Department Downtown. The Case Manager Assistant provides hands-on acute care Utilization Review, Payer Authorization status and Discharge Planning Services to our hospitalized and emergency room patients, as directed and assigned by a Registered Nurse Case Manager (CM) or Social Worker, in accordance with department policies and procedures.

Essential Functions

* Consistently demonstrates job performance which reflects commitment to the Mission, Vision and Values of SGMH.
* Prepare CM assignment packets according to daily schedule
* Prepare and fax referral packets for SNF, HH, DME, and any home medications with necessary documentation/information to appropriate company/facility.
* Follow up on referrals by phone to ensure receipt of referral to intended company/facility and ensure all necessary information/documentation was provided.
* Receive and respond to all fax/phone requests from facilities/companies and provide pertinent information to acquire approval/placement for patients needs on behalf of Case Managers.
* Notify Case Manager and/or Social Worker assigned to patient upon receipt of new orders for consultations.
* Follow up with Payers/Insurance companies as needed for patients to acquire authorization and preferred placement/DME/transport information.
* Verify patient personal information at bedside as needed for HH/DME needs upon discharge.
* Document all steps/conversations/information obtained with patient/patient family members/facilities/DME companies/agencies throughout the process of consult, inclusive of Patient Choice selection within the appropriate software systems.
* Update all lists such as Insurance Matrix, home health/hospice agencies, acute transfer facilities, skilled nursing facilities etc. as new information is obtained and distribute new lists to Case Managers.
* Receive authorizations/reference codes from insurance companies via phone and fax, document in appropriate systems, and forward to Business Office as needed.
* Obtain information for insurance companies when unknown in order to determine where to send Interqual upon daily clinical review and add information to IPA/Insurance matrix.
* In the event of a Medicare appeal, copy chart and fax to contracted company, call within twenty four hours to ensure receipt of chart in order to abide by Medicare guidelines. Document in chart and include confirmation of receipt of fax.
* Assist the Discharge Planner by setting up home health/hospice needs according to MD orders on a case by case basis while under the direct supervision of the Social Worker/RN Case Managers. Prepares appropriate discharge packets. Keeps the supervising Case Manager/Social Worker updated on progress and status of referral and is able to chart appropriate documentation upon finalization of discharge needs.
* Able to assist with distribution of Important Message of Medicare to Medicare Beneficiaries and document in appropriate software programs.
* Meets hospital continuing education requirements by enhancing professional growth and development through participation in educational programs, current literature, in-service meetings and workshops, as well as association groups
* Maintains required competencies
* The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent in the job.

Job Requirements

Minimum Experience

* Minimum of one (1) year experience with verification of insurance, obtaining authorizations, ICD-10 coding preferred.
* Two (2) years experience in related healthcare required.
* Knowledge of medical terminology required.

Education

Associate Degree preferred. High School diploma or equivalent required.

Required Skills

* Must have excellent clerical skills. This would include the ability to multitask and have strong organizational skills
* Must have excellent communication/people skills in person and on the phone.
* Proficient computer data entry skills required.
* Demonstrates the knowledge and skills necessary to provide care appropriate to the age (age refers to newborn, infant, toddler, preschool, school age, adolescent, adult, and senior) of the patients in the unit as outlined in established procedures.
* Demonstrates knowledge of the principles of growth and development over the life span of the patient.

LifePoint Health is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans status or any other basis protected by applicable federal, state or local law.