Overview
How have you impacted someone's life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career, all within New Jersey's premier healthcare system.
The Care Coordination Specialist performs selected services and functions related Transitions of Care & Utilization Management, including insurance authorization, payer communications, Appeals and Denial information, and scheduling.
Responsibilities
A day in the life of an Care Coordinator Specialist at Hackensack Meridian includes:
Essential Generic Job Functions:
- Utilization Management
- a. Payer communications responds to requests and inquiries and provides information as requested.
- b. Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process.
- c. Providing patients with the IM Letter from Medicare prior to discharge.
- d. In collaboration with the Care Coordinator (CC), reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed. Alerts the CC to potential problems with any of the above.
- e. If the authorization/precert information is missing or incorrect, the Specialist will contact admitting to obtain the necessary and accurate information.
- f. Daily log reconciliation.
- g. Utilizes Information System to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process.
- h. Retrieves information for the Physician Advisors as needed.
- i. Works the discharged not final billed (DNFB) report to determine outlier days, approved days, etc., and releases accounts as appropriate.
- j. Verifies admission and discharge date information.
- k. Updates Utilization Review RN needed for payors. l. Enters all documentation into EPIC/Applicable IT system for denials/ lower level of cares.
- Insurance Authorizations
- a. Contacts insurance companies for benefit coverage and obtains authorizations when needed.
- b. SAR
- c. Ambulance Transport.
- Post - Acute Care Referral Management
- Manages Referrals to external facilities & services including but not limited to the following: 1. Assisted Living Facilities
- Acute Rehab
- Subacute Rehab New referrals & Returns
- LTAC
- Hemodialysis New & Returns
- DME
- Hospice
- Palliative Care
- Wound Care
- Home Health Services
- Community Resources
- b. Obtains necessary supportive information from the medical record.
- c. Manages Referral Documentation.
- Appointment Scheduling
- a. As requested, arranges Medicaid appointments.
- b. As requested will arrange follow up appointments at MD?s office and/ or clinics.
- Additional Duties
- a. As requested faxes medications, once received from CC to a particular pharmacy.
- b. As requested faxes EARC or PASSR to State of NJ Offices.
- c. As requested faxes applications for Medication assistance.
- d. All other duties as assigned.
- Adheres to HMH Organizational competencies and standards of behavior.
Qualifications
Education, Knowledge, Skills and Abilities Required:
- High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
- Effective written, oral, and interpersonal communications skills.
- Proficient computer, word-processing and Excel spreadsheet skills.
- Ability to learn new computer systems, i.e.: EPIC, INDICIA.
- Educated in the unique clinical and discharge needs of the patients.
- Strong time management and priority-setting skills.
- Ability to work independently and as a team member.
- Self-directed with the ability to take the initiative to solve problems.
- Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.
Education, Knowledge, Skills and Abilities Preferred:
