This position works collaboratively with other members of the Clinical Care Coordination team to ensure that authorization requests, provider and member inquiries are handled appropriately, within established timeframes and utilizing established guidelines.
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Conduct Outbound Communication: Place calls to Case Management and Utilization Review departments to verify patient admission status, coordinate repatriation transportation, and track skilled nursing facility (SNF) placement status to obtain clinical updates, discharge orders, and final discharge dispositions.
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Audit Admissions Log: Conduct routine audits of out-of-network admission to ensure accurate documentation of non-repatriation reasons/codes, patient status, admit type and admit source.
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Manage Authorization Requests: Create and process inpatient and transportation authorizations via fax, email, or phone call.
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Facilitate Clinical Reviews: Execute the end-to-end processing of clinical reviews, assist request necessary referral packets for Skilled Nursing Facilities (SNF) and other Higher Levels of Care (HLOC).
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Bed Days (Members Still in House): Filter and manage daily bed day logs, executing required notification processes and system revisions to ensure data accuracy.
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Verify Eligibility and Provider Info: Confirm member eligibility and validate hospital provider information to ensure all records meet departmental compliance standards.
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Identify Repatriation Barriers: Assist Case managers in identifying and resolving barriers to repatriation, such as bed availability or clinical instability, to promote the return to in-network care.
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Provide Administrative Case Support: Assist Case Managers with non-clinical tasks including PQI cases, NOA/LOA documentation, CCS case processing, and "Carve Out" transitions.
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Required 1 + years of experience as an Inpatient Coordinator
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Required experience with EZ cap, Right Fax, 3cx phone system and EHR applications.
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Required intermediate Microsoft Outlook Proficient in Microsoft Office such as Outlook, Word and Excel.
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Proficient in interpersonal/verbal communication skills.
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Intermediate ability to effectively present information and respond to questions from peers and management.
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Intermediate ability to work effectively within group to achieve desired outcomes.
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Required 2+ years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties.
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Highly Motivated and Positive Attitude
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High level multi-tasker
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Problem Solving skills
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Clear Communication Skills and Active Listener
