Continuum Care Support Specialist

2 weeks ago

Atlanta, Georgia, United States Kaiser Permanente Full time

Job Overview:

The Continuum Care Coordinator plays a vital role in managing all non-clinical operations within the Continuum framework. This position is essential in assisting Case Managers and Physicians with their daily tasks, ensuring the accuracy and integrity of data across both inpatient and outpatient services. The Coordinator is responsible for the collection, analysis, and reporting of utilization management data for Kaiser Permanente's Continuum services.

Key Responsibilities:

  • Assist in all non-clinical operations within the Continuum.
  • Facilitate discharge planning for members across various care levels.
  • Respond to inquiries from patients, vendors, and healthcare providers via phone, managing a high volume of calls daily.
  • Work effectively in a call-centric environment, meeting established performance metrics.
  • Ensure productivity in a fast-paced setting to meet the needs of members and healthcare providers.
  • Input authorization and referral data into necessary systems, maintaining accuracy in all relevant fields.
  • Review and update authorizations daily to ensure the precision of Tapestry Census Reports.
  • Document external medical services and manage referrals for all levels of care.
  • Verify eligibility and benefits for all admissions and conduct follow-ups as required.
  • Coordinate data collection and reporting processes, providing timely analytics support.
  • Collaborate with various organizational units and external facilities to obtain and verify necessary information.
  • Educate members, physicians, and hospitals regarding covered benefits and related inquiries.
  • Assist members during the claims review process, coordinating both authorized and non-authorized claims.
  • Manage transportation coordination and authorization reviews for air and ground services.
  • Oversee the procurement of durable medical equipment for members.
  • Maintain the integrity of utilization tracking management systems.
  • Schedule appointments for members and coordinate necessary care.
  • Process pended claims in Tapestry, ensuring proper follow-up and resolution.
  • Prepare and distribute Tapestry census reports for case rounds.
  • Compile necessary documentation for referrals and assist case managers as needed.

Basic Qualifications:

Experience:

  • At least two (2) years of relevant experience in a similar role.

Education:

  • High School Diploma or General Education Development (GED) is required.

Licenses and Certifications:

  • Must obtain a Certified Professional Coder, Certified Outpatient Coder, or Certified Coding Specialist certification within six months of hire.

Additional Qualifications:

  • Strong analytical, critical thinking, and problem-solving skills.
  • Excellent verbal and written communication abilities.
  • Proficient in data tracking and spreadsheet management.
  • Knowledge of health plan benefits and medical center operations.
  • Experience with ICD, CPT, and HCPCS coding systems.
  • Familiarity with healthcare payment mechanisms.
  • Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, etc.).
  • Exceptional customer service skills.

Preferred Qualifications:

  • Clinical background is preferred.
  • Medical Terminology Certification is a plus.
  • Bachelor's degree is preferred.

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