1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and reports suspected violations.
2. Assists in referring and faxing of discharge referrals to outside agencies (skilled nursing, sub-acute and acute care facilities, transitional care, rehab services, home health agencies, DME companies and other providers).
3. Assists in facilitating acquisition of appropriate insurance information and authorization prior to discharge.
4. Assists in ensuring completion of all necessary post discharge paperwork and sends to provider as directed.
5. Confirms agency/facility acceptance and time of transfer; makes transportation arrangements as directed; routinely and timely communicates this information via email and/or verbally to appropriate Case Manager, Social Worker or Nurse Navigator.
6. Performs phone calls and faxes information to complete Medi-Cal 10-bed call list and other bed searches; documents bed search information in medical record.
7. Communicates results of Medi-Cal 10-bed search and other bed searches to appropriate Case Manager, Social Worker or Nurse Navigator; informs them of barriers to acceptance and potential accepting facilities in order for them to communicate to patient/family and facility as needed.
8. Assists in preparing patient packets when needed, i.e., by copying medical records, printing reports from computer, collating required information and preparing transfer envelope.
9. Communicates with leadership when issues or needs for process changes are identified.
10. Maintains community resource list.
11. Assists in the distribution of Medicare IMM letters and in obtaining signatures, if applicable.
12. Assists with Medicare appeals by gathering all information, faxing to the QIO, confirming that information was received, completing log, following up on outcome and communicating with appropriate team, if applicable.
13. Assists in making PCP post discharge appointments of high risk patients as needed to prevent readmissions.
14. Assists in taking-off and communicating voice mail messages.
15. Asks for help when necessary and willingly assists co-workers when necessary to promote efficiency and to provide quality service.
16. Determines priority in workload; completes a typical day s assigned workload within the scheduled shift.
17. Maintains current knowledge and awareness of payer reimbursement practices and regulations impacting the patients plan for care and discharge plan.
18. Performs other duties as assigned.
Problem solving skills to identify issues and formulate effective solutions
Knowledge of payer types including Medicare, SR HMO , Medi-Cal and Private Payers
Ability to effectively communicate in a positive and professional manner
Written and verbal communication skills
Self-starter; driven to take action without needing prompting
Ability to use Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications
Epic knowledge, Good communication skills, clerical support to case managers social workers, etc.