Transitional Care Specialist
Position PurposeThis position will provide agency operations support by initiating and maintaining all aspects of patient episodes of care including, but not limited to, referral processing and compliance efforts, authorizations and denials/investigations, patient and clinical team scheduling, quality auditing, and patient experience projects. The position will also assist leadership in all preparations for The Joint Commission and other regulatory surveys (i.e. Probe and Educate requests).This position is responsible for ensuring operational accuracy through daily episode of care analysis, quality reporting, and identification of compliance discrepancies. High level organizational and problem-solving skills are necessary. Specific patient caseloads will be assigned by leadership. This position will require detailed knowledge and use of Epic, Midas, and all insurance request websites (Medicare, Medicaid, Amerigroup, etc.). Interactions with the Central Business Office, IT, Revenue Cycle IT, and external referral sources will be frequent and monitored by leadership.This position will be assigned additional administrative and operational tasks as needed.Nature and ScopeThe nature and scope of managing designated caseloads will include:
oAdministrative maintenance of all episodes of care for patient caseload.oReviewing reports in Epic and analyzing results regarding agency quality initiatives.oUtilizing several insurance websites in order to request and obtain authorizations/investigate denials. Collaboration with the Central Business Office is needed during such investigations.oProcessing new referrals and ensuring receipt of documentation specific to Home Health/ Hospice conditions of participation and compliance standards. Reaching out to doctors' offices on a regular basis.oTroubleshooting referral issues/concerns and working with leadership to streamline and improve experience for referring agencies/MDs/etc.oMaintaining up-to-date knowledge of all related standards and requirements for new patients. Collaborating with Clinical Leadership to ensure all accepted patients are clinically appropriate for Home Health / Hospice Services.oCollaborating with clinical staff to ensure all patients are seen in a timely manner and in accordance with physician orders.oParticipate in quality improvement and change management procedures and processes.oOwn and regularly review DNBs and Stop Bills to ensure appropriate billing.oMaintaining HARs (Hospital Account Records) and closing when appropriate.oMaintain regular contact with all patients on caseload. Consistently verify that services are going well, that patient is safe at home, and that all inquiries are addressed timely.oUtilize Midas for safety event and compliance reporting.oParticipate in agency Interdisciplinary Team meetings.oParticipate, as needed, in Emergency Operations, Forms Committee, Home Health / Hospice QAPI.Overall, under the direction of the Leader/Director, shall work closely with Other appropriate departments.This position does not provide patient care.DisclaimerThe foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.Minimum QualificationsRequirements - Required and/or PreferredNameDescriptionEducation:
Must have working-level knowledge of the English language, including reading, writing and speaking English. High school diploma or equivalent. Associate's degree preferred.
Experience:
Two years of quality experience, word processing and spreadsheet. Knowledge and application of Home Health operations preferred. Strong organizational and communicative skills.License(s):
NoneCertification(s):
NoneComputer / Typing:
Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Recommended Skills Administration Billing Change Management Clinical Works Communication Hospice Apply to this job. Think you're the perfect candidate? Apply on company site $('.external-apply-email-saved').on('click', function (event) window.ExternalApply = window.open('/interstitial?jobdid=j3m87j76bwcbhgg7cfj', 'ExternalApply-j3m87j76bwcbhgg7cfj'); ); $(document).ready( function() $(#ads-desktop-placeholder).html(
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n Estimated Salary: $20 to $28 per hour based on qualifications.
oAdministrative maintenance of all episodes of care for patient caseload.oReviewing reports in Epic and analyzing results regarding agency quality initiatives.oUtilizing several insurance websites in order to request and obtain authorizations/investigate denials. Collaboration with the Central Business Office is needed during such investigations.oProcessing new referrals and ensuring receipt of documentation specific to Home Health/ Hospice conditions of participation and compliance standards. Reaching out to doctors' offices on a regular basis.oTroubleshooting referral issues/concerns and working with leadership to streamline and improve experience for referring agencies/MDs/etc.oMaintaining up-to-date knowledge of all related standards and requirements for new patients. Collaborating with Clinical Leadership to ensure all accepted patients are clinically appropriate for Home Health / Hospice Services.oCollaborating with clinical staff to ensure all patients are seen in a timely manner and in accordance with physician orders.oParticipate in quality improvement and change management procedures and processes.oOwn and regularly review DNBs and Stop Bills to ensure appropriate billing.oMaintaining HARs (Hospital Account Records) and closing when appropriate.oMaintain regular contact with all patients on caseload. Consistently verify that services are going well, that patient is safe at home, and that all inquiries are addressed timely.oUtilize Midas for safety event and compliance reporting.oParticipate in agency Interdisciplinary Team meetings.oParticipate, as needed, in Emergency Operations, Forms Committee, Home Health / Hospice QAPI.Overall, under the direction of the Leader/Director, shall work closely with Other appropriate departments.This position does not provide patient care.DisclaimerThe foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.Minimum QualificationsRequirements - Required and/or PreferredNameDescriptionEducation:
Must have working-level knowledge of the English language, including reading, writing and speaking English. High school diploma or equivalent. Associate's degree preferred.
Experience:
Two years of quality experience, word processing and spreadsheet. Knowledge and application of Home Health operations preferred. Strong organizational and communicative skills.License(s):
NoneCertification(s):
NoneComputer / Typing:
Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Recommended Skills Administration Billing Change Management Clinical Works Communication Hospice Apply to this job. Think you're the perfect candidate? Apply on company site $('.external-apply-email-saved').on('click', function (event) window.ExternalApply = window.open('/interstitial?jobdid=j3m87j76bwcbhgg7cfj', 'ExternalApply-j3m87j76bwcbhgg7cfj'); ); $(document).ready( function() $(#ads-desktop-placeholder).html(
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n Estimated Salary: $20 to $28 per hour based on qualifications.
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