Participate and assist in daily case management operations, including: assist with utilization management workflow and payer contacts; assist with coordination of all referral types, products, and equipment; facilitating and engaging in bi-directional communication with health care professionals ensuring the accurate and timely dissemination of referral information to facilitate a smooth patient transition to the next level of care; computer data entry in multiple systems; participation in quality assurance, and regulatory compliance activities as needed; and demonstration of competence for working with all patient age groups. Schedule will be 9:30 AM-6:00 PM. Required to participate in weekend and holiday rotation(s).
Essential
- Accurately and comprehensively disseminate all necessary referral information to vendors in order to facilitate the transition to the next level of care for the patient.
- Communicate effectively with all stakeholders inclusive of Care Management staff, insurance carriers and/or their designated intermediaries, and vendors to ensure that transition information is current, accurate, and complete.
- Provide concise, applicable, and timely responses to requests for information from vendor/insurance providers using a systematic, efficient, and thorough procedure for retrieving information.
- Create and maintain accurate communication in electronic medical record and other applicable software programs as specified by UMHS Care Management Department policy and procedure.
- Contribute to the achievement of UMHS Care Management Department goals through effective participation in work groups.
- Maximize work efficiency through the use of computers and other technologies as evidenced by proficient skill in accessing and disseminating referral and patient care information.
- Maintain confidentiality of patient and proprietary information by observing legal and ethical guidelines for safeguarding the confidentiality of patient and proprietary information.
- Provide callers with assistance and redirect calls as needed to appropriate personnel.
- Appropriately distribute any correspondence received via FAX, email, phone calls, mail or voicemail as required.
- Confirm admissions to post-acute care with vendors and provide appropriate documentation.
- Initiate EMR documentation for Care Management staff co-signature after verification of discharge disposition.
- Initiate and follow through on appropriate referrals and document in EMR for co-signature by Care Management staff.
- Communicate with patients/caregivers when initiating referrals and follow department referral guidelines.
- Upon direction from Care Management staff assist with obtaining insurance authorization.
- Facilitate timely submission of documentation for appeals.
- Schedule and confirm transportation as directed by Care Management staff.
- Assists in obtaining and documenting insurance authorizations and approval days in multiple computer programs.
- Maintain updated/accurate contact information for vendor/insurance provider in appropriate data base.
- Print and deliver packets to units for facility discharges.
- Maintain CMS compliance with notice deliveries and consents.
Other Related Duties:
- Complies with all University of Michigan Health System and departmental standards and expectations.
- Supports the department’s commitment to continuous improvement activities and principles through positive and respectful contribution in all problem-solving and change processes.
- Performs other duties as assigned.
- High school diploma or general education equivalency
- 3-4 years experience
- Familiarity with obtaining medical records or professional medical billing
- Financial counseling experience for healthcare patients
- Excellent interpersonal skills and ability to work well within a team setting
- Demonstrates active listening, written, verbal and information technology skills
- Knowledge of basic medical terminology
- Analytical skills are necessary in order to assess urgency and complexity of request so prioritization of workflow can be achieved effectively
- An Associate degree in social sciences or other health related field or an equivalent combination of education and experience is necessary.
- Experience in the health care environment with a demonstrated knowledge of regulations, standards, and guidelines applicable to home care services.
- Proficiency in medical terminology.
- Proficiency in use of computer technology and experience with Microsoft Office software applications.
OCCUPATIONAL HAZARD INFORMATION:
The work inherent to this position resides in the health care and office environment settings; exposure to office supplies and equipment is ordinary; exposure to the general health care population is