Intake/Authorization Coordinator Home Health - Outcome HC

DUTIES AND RESPONSIBILITIES:

Intake:

• Identifies and verifies insurance coverage of home health care services. 

• Collaborates with the hospital’s discharge planning personnel, utilization review department and insurance Case Managers to facilitate safe, early discharge. 

• Consults with physicians, nurses, social workers, discharge planners and other disciplines to establish a coordinated home plan of care. 

• Interviews the patient, family, and caregiver and discusses the home situation, current needs, and any psychosocial factors that are relevant to the plan of care. 

• Completes referral information that includes intake data, essential background information, hospital course, and the plan of care. 

• Inputs all necessary information regarding patient and referral into our EMR

• Maintains liaison relationship with hospital and insurance personnel, providing information and education on home health services, coverage issues and related areas. 

• Collects and maintains statistical data on all referrals and submits them regularly as required.

• Collects and maintains statistical data on all referrals and submits them regularly as required. 

• Has worked with Wellsky to communicate with Hopsital regarding referrals.

Authorization:

• Obtains and documents prior authorization for home care services from insurance providers

• Coordinates home care services for managed care patients, assists with the establishment of the plan of care in coordination with the physician and insurance case managers, and ensures a seamless transition to home care. 

• Verifies insurance coverage and obtains initial authorizations for services and seeks reauthorization for ongoing and additional services. 

• Works with clinical supervisors and staff clinicians to gather, collate, and report patient care summary information to managed care Case Managers. 

• Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions. 

• Works with members of the billing team to ensure that managed care customers are billed according to Case manager agreements. 

• Establishes and maintains positive working relationships with current and potential managed care customers. 

• Promptly responds to managed care customer’s requests and concerns.

• Assists in building community, customer, payer and patient perceptions of Home Health Service as a high-quality provider of services. 

• Maintains comprehensive working knowledge in the field of managed care and shares information with appropriate organization personnel. 

• Maintains comprehensive working knowledge of community resources and assists customers in accessing community resources should services not be provided by home health service.

Other:

• Answers telephones and screens to direct calls appropriately.

• Maintains the confidentiality of all financial and medical records. 

• Takes and relays messages to appropriate parties.

• Provides general administrative and clerical support

• Attends meetings and participates in inservices/education as required.

• Assists with new employee orientation relative to intake and insurance authorization.

• On call rotation, as required. 

• Performs all other duties as assigned.

The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description. 

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Education and/or Experience - High school diploma or general education degree (GED) required; 1 year of medical office experience required.

• Language Skills – Ability to read, analyze, and interpret common patient information, medical documentation and insurance information. Ability to respond to common inquiries or complaints from clients, vendors, doctor’s offices, insurance agencies, regulatory agencies, or members of the business community. Ability to effectively present information to management and co-workers. Ability to interact clearly and effectively, in both written and oral communication, with supervisor, clients, staff, venders, etc.       

• Mathematical Skills – Ability to apply concepts such as addition, subtraction, multiplication and division.

• Computer Skills - To perform this job successfully, an individual should be proficient in personal computer skills including electronic mail, record keeping, routine database activity, word processing, spreadsheet, etc. This role requires an above-average knowledge of Microsoft Office, Spreadsheet math, Web based billing.

• Other Qualifications - Strong organizational Skills and understanding of information storage and retrieval required.

COMPETENCIES:

• Communication- Communication refers to the ability to inform orally and in writing, with clarity and good effect. It means to understand clearly and quickly when instructions or orders are received. It means judgment about what information is important and what is not, and what should be communicated, how, to whom and when.

• Interpersonal Skills-Relates well to all kinds of people, up, down, and sideways, inside and outside the organization, builds appropriate rapport, builds constructive and effective relationships, uses diplomacy and tact, can diffuse even high-tension situations comfortably. Supports organization's goals and values. Benefits organization through outside activities. Can cause or influence a joint action by a number of people to achieve a desired result. Understands others quickly and can find common ground. Practices attentive and active listening. Has patience to hear people out and can accurately restate the opinions of others even when he or she disagrees. Provides the information people need to know how to do their jobs and to feel good about being a member of the team.

• Learning Skills-Learns quickly when facing new problems. A relentless and versatile learner. Open to change. Analyzes both successes and failures for clues to improvement. Experiments and will try anything to find solutions. Enjoys the challenge of unfamiliar tasks. Quickly grasps the essence and the underlying structure of anything. Picks up on things quickly. Can learn new skills and knowledge. Is good at learning new skill and does well in educational courses and seminars. Demonstrates relevant knowledge and skill including awareness and possession or mastery of special facts, practices, manual skills, techniques and decision-making methods.

• Priority Setting-Spends his/her time and the time of others on what's important. Quickly zeros in on the critical few and puts the trivial many aside. Can quickly sense what will help or hinder accomplishing a goal. Eliminates roadblocks. Creates focus.

• Problem Solving-Refers to the ability to solve difficult problems with effective solutions. Can make decisions in a timely fashion that are sound, accurate and supported by the reasoning and inclusion of appropriate people

• Work Quality-Work quality refers to the effort that consistently achieves desired outcomes with a minimum of avoidable errors and problems. Follows policies and procedures. Completes administrative tasks correctly and on time.