Admissions and Authorizations Specialist Full Time Remote

Job Summary

Responsible for the completion of the entire admission process including the development and maintenance of customer relations with internal referral sources. Demonstrate accountability for and contribution to program development, quality improvement, problem solving and productivity enhancement in an interdisciplinary model. Serves as a liaison with marketing, business office and administration of the facilities. Coordinates and plans the daily operation for all pre-admission activities. Coordinates admission with other departments by collecting and distributing the appropriate information. Identifies information needed from the referring hospital to finalize the admission.

Essential Functions

• Coordinates the patient admission functions in keeping with the mission and vision of the hospital.
• Coordinates and facilitates the admission of patients from the referral sources.

1.    Applies appropriate clinical guidelines to pre-admission data.
2.    Identifies and communicates specific patient needs for equipment, supplies, Pharmacy and consult services.
3.    Complete initial review of referral for clinical and financial approval and/or escalation to leadership for approval.
4.    Complete/Review verification of admission insurance benefits and handles requirements for pre-certification of admission.
5.    Complete pre-certification and load precertification into Referral Manager for managed care referrals
6.    Coordinate denial management process including coordinating Peer to Peer and initiating expedited appeal for insurance denials.
7.    Provides hospital team with needed information on pending/new admissions.
8.    Coordinate bed availability with nurse manager.
9.    Expedites transfer.

• Participate in continuing education/ professional development activities.
• Communicate and demonstrate a professional image/attitude for patients, families, clients,
  coworkers and others.
• Adhere to policies and practices of Scion Health.
• Learn and develop full knowledge of the Central Admissions Department (CAD) Admission process
• Learn and have a full understanding of scheduling and pre-register routines in Meditech and referral platform.
• Learn and develop a full understanding of referral manager to execute data entry and updates necessary to ensure data integrity, and proper admission.
• Develop positive relationships and establish open communication with referral sources including internal/external hospital case managers, social workers, nursing staff, physicians, and third-party payor representatives
• Develop positive relationships and establish open communication with internal customers including Clinical Liaisons, CAD teammates, Patient Assessment Coordinators and Scion Hospital leaders and staff.

Knowledge/Skills/Abilities/Expectations

• Excellent oral and written communication and interpersonal skills.
• Strong Computer skills with both standard and proprietary applications
• Must have good and regular attendance.
• Approximate percent of time required to travel: 0
• Performs other related duties as assigned.

Education

• Graduate of a bachelor’s degree program with a healthcare related area of concentration or be a licensed health care provider or equivalent experience.

Licenses/Certification

• Healthcare professional licensure preferred, but not required; includes Registered Nurse, LPN/LVN, Respiratory Therapist, Physical Therapist, Occupational Therapist, or Social Worker.

Experience 

• Experience in a healthcare related area is preferred. 
• Work experience with an adult geriatric disabled population is desirable.