Provides direct support to the multi-disciplinary team to anticipate and plan for the continuum of care and discharge needs.  Works closely with patient, families, health care team, payers and community resources in order to facilitate and coordinate all of the components of the safe discharge of patient from an inpatient location in a timely manner to less restrictive level of care per the direction of the Care Manager. Communicate effectively with stakeholders including team members to ensure the timeliness of initial and ongoing authorizations for patient care services.  The individual will also be accountable to work with third party payors to obtain retro authorizations for services.  The individual will seek and record authorizations from third party payors.  Support the general operation of the department, remaining flexible at all times.  Customer service is an essential element of the position.  Responsible for assisting physicians, patients, and hospital staff with their needs as they relate to the functions of the department.

Essential Duties and Responsibilities

These duties and responsibilities described below represent the general tasks performed on a

daily basis.  Any other duties as needed to drive to the vision fulfill the mission and abide by

the values of the organization

• Communicates with payors to begin the authorization process for ltac, IPR, snf and long term cars directed by the care manager.   Documents actions in the medical record
• Communicates status of authorization to all parties involved
• Follow up with payors to obtain authroizations within 24 hours of ask
• Send updated progress notes as needed by the payor to obtain authorization
• Enters discharge information in systems without interface.
• Gathers pertinent information from financial payers to identify benefit coverage for post acute providers.
• Provides prompt feedback regarding payor determinations to Care Managers enabling them to evaluate/re-direct the current patient plan of care in order to streamline the delivery of service.
• Interacts with the patients’ payor to confirm patient’s benefits and identify preferred providers.
• Uses electronic software to distribute post acute placement requests to home health, Itac, snf, al, dme, etc.
• Follow up with post discharge providers regarding determination.
• Work with post acute providers to obtain authorizations for services and provide communication to the CM/SW team.
• Monitor request activity for messages sent by facilities and vendors and take appropriate action to complete the discharge process.
• .Communicates well with staff, physicians and ancillary services.  Projects a professional attitude when working with other departments, medical staff, and nursing administration guests of the hospital and outside agencies.
• Actively participates in service recovery and customer service activities to ensure a superior customer contact.
• Adhere to CRMC’s confidentiality policy for all information related to patients, family and friends, hospital employees, physicians and clients.
• Maintains effective interdepartmental communication.
• Initiates the referral for nursing home’s, hospice, assisted living.
• Utilizes e-discharge and or fax to communicate with facilities.
• Documents in data collection system.
• Communicate effectively with stakeholders to ensure the timeliness of initial and ongoing authorizations for patient care services.  Maintain accurate and complete clinical documentation and records according to appropriate policies, procedures and professional standards.
• Enters and maintains certification information in appropriate information system.
• Must be able to extract the necessary clinical information from the medical record to support acute care admissions.  Must utilize necessary resources such as history and physicals, laboratory, radiology reports etc. in order to obtain the needed information required by payors insuring approval for retro authorizations.

Education and Experience

Education:  High school diploma or equivalent required.  Knowledge of medical terminology.   Associate degree in a health care field preferred (Health Information Technology, Medical Assistant, etc).

Experience:  Minimum of one year experience in an acute care setting preferred.  Strong knowledge of medical terminology.  Strong computer skills in a Windows environment.  Must be able to operate/utilize fax machine, copy machines, scanner, and Windows-based computer functions. Experience with Third Party Reimbursement or Utilization Management.  Have strong knowledge of medical terminology.  Excellent written and verbal communication, interpersonal, organization and problem solving skills.  Demonstrated knowledge and competency in computer applications. 

Personal Qualifications:  Strong customer service orientation.  Detail oriented.  Must be courteous and exhibit very good communication skills.  Must be able to exercise judgment, compassion, honesty, and respect for others in performance of job duties.  Must be able to work independently with attention to detail and accuracy.  Present self in a positive manner as reflected by personal attire and etiquette.

Certificates, Licenses, Registrations : None