Coo

2 weeks ago

Greenville, United States Prisma Health Full time

Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible for the financial and clinical aspects of all referrals made to the program, including logging all referrals, collecting and verifying pertinent demographic and financial data as well as obtaining pre-certifications and authorizations for new and ongoing treatment. Interacts regularly with internal customers, third party payors and outside referral sources. Performs complex tasks using Microsoft Office applications. Responsible for compliance issues related to medical necessity and coding.

Essential Functions

  • All team members are expected to be knowledgeable and compliant with Prisma Health‘s values: Inspire health. Serve with compassion. Be the difference.

  • Processes and tracks incoming referrals. Logs all incoming referrals according to program guidelines. Obtains medical records to support referrals. Prepares referral with clinical and financial information for submission to Program Director. Coordinates patient assignment to case management and communicates with referral source as to the status of the referral.

  • Advocates for and secures coverage for all patients referred for services. Explains the unique aspects of the program to insurance representatives and provides the program description to all third-party payors in order to increase accuracy of pre-certification determinations and financial information. Verifies insurance benefits to include all possible services and codes billed by program and need for pre-certification or pre-authorization for treatment. Pursues any needed clarification of insurance benefits prior to scheduling of patients.

  • Obtains staffing requirements related to third party payors based on requirements for in-network providers and communicates information to case management to maximize reimbursement.

  • Maintains public relations with patients and third-party payors, including insurance case managers.

  • Collects and verifies pertinent patient demographics and financial data on all new patient referrals with physician offices and other referral sources. Communicates with referral source to obtain additional information required for completing referral, including ICD-9 coding as well as ascertaining appropriate medical records to determine eligibility for program admission.

  • Collects and verifies pertinent patient demographics and financial data on all ongoing patients under continuing treatment. Obtains continuing authorizations for treatment under 3rd party payor guidelines andtime framesand completes required documentation. Facilitates documentation needs by third party payors for continuing treatment. Provides initial advocacy and informational needs for recurring treatment withthirdparty payors and notifies case management ofadditionalcontact required.

  • Performs compliance functions related to coding, billing, demographics and payor source. Facilitates codes on initial orders. Coordinates supplemental coding to support medical necessity of treatment and communicates to in a timely manner. Monitors timeliness of physician continuing orders for treatment for all program and patients.

  • Coordinates patient scheduling process, updates waiting lists, prepares written communication to physicians regarding referrals and performs database entry.

  • Performs other duties as assigned.

Supervisory/Management Responsibilities

  • This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Education

  • Education - High School diploma or equivalent

  • Experience - Two (2) years in insurance, billing, collections, customer service and/or healthcare business office.

In Lieu Of

  • NA

Required Certifications, Registrations, Licenses

  • NA

Knowledge, Skills and Abilities

  • Able to use MS Office applications

  • Knowledge of ICD-10 and CPT coding conventions- Preferred

Work Shift

Day (United States of America)

Location

Roger C Peace Rehab Hosp

Facility

1010 Roger C Peace Rehabilitation Hospital

Department

10109079 Post-Acute Bed Placement

Share your talent with us Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

  • Coo

    4 weeks ago

    Greenville, United States Universal Health Services, Inc. Full time

    Responsibilities Glen Oaks Hospital is a 54-bed private mental health hospital in a relaxed setting in Greenville, Texas. Our comfortable, homelike atmosphere is conducive to healing for the adults and seniors we treat. Our greatest asset is the staff, comprised of psychiatrists, professional nurses, social workers and therapists. These individuals work as...

  • Safety and Security Support Clerk

    2 weeks ago

    Greenville, United States New Horizon Family health Services INC Full time

    NEW HORIZON FAMILY HEALTH SERVICES, INC. POSITION DESCRIPTION JOB TITLE: Safety and Security Support Clerk DEPARTMENT: Operations SUPERVISOR: Chief Operating Officer/Safety & Security Manager STATUS: Non-Exempt IMPORTANT NOTE THIS DOCUMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT JOB SUMMARY: Under the supervision of the...

  • Prisma Health,VP-Supply Chain Management

    2 months ago

    Greenville, United States Telamon Group Full time

    Telamon Group is proud to represent Prisma Health as they recruit an inspirational leader as the VP-Supply Chain Management reporting directly to EVP/COO.This position offers an exceptional leadership position for an experienced, innovative leader to advance healthcare across Prisma Health.Working closely with the Executive Vice President and COO, the Vice...

  • Prisma Health,VP-Supply Chain Management

    1 month ago

    greenville, United States Telamon Group Full time

    Telamon Group is proud to represent Prisma Health as they recruit an inspirational leader as the VP-Supply Chain Management reporting directly to EVP/COO.This position offers an exceptional leadership position for an experienced, innovative leader to advance healthcare across Prisma Health.Working closely with the Executive Vice President and COO, the Vice...

  • Prisma Health,VP-Supply Chain Management

    2 months ago

    greenville, United States Telamon Group Full time

    Telamon Group is proud to represent Prisma Health as they recruit an inspirational leader as the VP-Supply Chain Management reporting directly to EVP/COO.This position offers an exceptional leadership position for an experienced, innovative leader to advance healthcare across Prisma Health.Working closely with the Executive Vice President and COO, the Vice...

  • Safety and Security Support Specialist

    1 week ago

    Greenville, South Carolina, United States New Horizon Family health Services INC Full time

    New Horizon Family Health Services INC is seeking a highly motivated Safety and Security Support Specialist to join our team.">The Safety and Security Support Specialist will perform a variety of routine duties, including maintaining the secure handling of interdepartmental and postal mail. The incumbent will also be responsible for making daily trips to...

  • Strategic Supply Chain Leader for Prisma Health

    3 weeks ago

    Greenville, South Carolina, United States Telamon Group Full time

    Job OverviewTelamon Group is proud to represent Prisma Health, a leading healthcare organization in the Midlands and Upstate markets of South Carolina. We are seeking an exceptional Strategic Supply Chain Leader to join our team as Vice President-Supply Chain Management.Key ResponsibilitiesDevelop and implement cost containment strategies to standardize key...

  • Healthcare Supply Chain Director

    3 weeks ago

    Greenville, North Carolina, United States Telamon Group Full time

    Telamon Group is proud to represent Prisma Health as they recruit a visionary leader for the VP-Supply Chain Management role, reporting directly to EVP/COO.This exceptional leadership position offers an opportunity for an experienced and innovative leader to advance healthcare across Prisma Health, serving more than 1.5 million patients annually.The Vice...

  • Chief Technology Officer

    3 weeks ago

    Greenville, South Carolina, United States Gerber Childrenswear LLC Full time

    Job Title: Chief Technology OfficerDescription:At Gerber Childrenswear LLC, we are seeking an exceptional Chief Technology Officer to spearhead the transformation of our technology landscape. Reporting directly to the COO, this strategic role requires a visionary leader with a deep understanding of legacy systems and experience in leading large-scale IT...

  • Estimator

    7 days ago

    Greenville, United States RoadSafe Traffic Systems Full time

    Title: EstimatorClassification: ExemptAbout The OrganizationRoadSafe Traffic Systems is the largest national provider of traffic safety products and services in the United States. RoadSafe serves customers in all 48 contiguous states through its network of more than 60+ branch locations. At RoadSafe, we offer competitive pay, growth potential, and an...

  • Vice President of Information Technology

    3 weeks ago

    Greenville, United States Gerber Childrenswear Full time

    Company Overview At Gerber Childrenswear, we stand for quality, everyday comfort, and safety. From the clothes we design, the fabrics we select, and our focus on sustainability and community, we have what babies need for their first 1000 days and from one generation to the next. Our Team Our mission is to be a trusted partner to those responsible for the...

  • Executive Assistant

    3 weeks ago

    Greenville, United States All's Well Full time

    Job DescriptionJob DescriptionWe are looking to hire an Executive Assistant for a well known drug and alcohol rehab facility in Greenville, SC. The ideal candidate will have a high skill set with Excel and form building in Adobe. Must also be able to interact professionally with 2 separate board of commissioners. NATURE OF WORK: Position performs a variety...