Continuum Care Support Specialist

2 weeks ago

Atlanta, Georgia, United States Kaiser Permanente Full time

Job Overview:

The Continuum Care Coordinator plays a pivotal role in managing non-clinical operations within the healthcare continuum. This position is essential in assisting Case Managers and Physicians with their daily responsibilities, ensuring the accuracy and integrity of data across all inpatient and outpatient services. The coordinator is responsible for overseeing data entry, analysis, and reporting related to utilization management and case management services.

Key Responsibilities:

  • Assist in all non-clinical operations throughout the care continuum.
  • Facilitate discharge planning for patients across various stages of care.
  • Respond to inquiries from patients, vendors, and healthcare providers, managing a high volume of calls daily.
  • Thrive in a call-centric environment while meeting established performance metrics.
  • Maintain productivity to address the needs of patients and healthcare providers effectively.
  • Input authorization and referral data into necessary systems, ensuring accuracy in diagnoses and care details.
  • Review and update authorization data daily to ensure the accuracy of census reports.
  • Document external medical services and manage referrals for all levels of care.
  • Verify eligibility and benefits for patient admissions and periodically thereafter.
  • Determine admission status based on physician orders and coordinate necessary authorizations.
  • Manage data reporting and collection processes, providing timely analytical support.
  • Collaborate with various departments and external entities to verify and reconcile billing information.
  • Educate members and healthcare providers on covered benefits and assist during the claims review process.
  • Coordinate transportation services and review authorizations for these services.
  • Manage durable medical equipment needs for patients.
  • Ensure the integrity of utilization tracking systems.
  • Schedule patient appointments and coordinate care as necessary.
  • Handle pending claims and ensure they are processed appropriately.
  • Prepare and distribute census reports for case management rounds.
  • Assist in compiling necessary documentation for referrals.

Qualifications:

Experience:

  • At least two (2) years of relevant experience in a healthcare setting.

Education:

  • High School Diploma or equivalent required.

Licensure and Certification:

  • Certification as a Professional Coder, Outpatient Coder, or Coding Specialist is required within six months of hire.

Additional Skills:

  • Strong analytical and communication skills, both written and verbal.
  • Proficient in data entry and management, with expertise in spreadsheets and tracking systems.
  • Familiarity with health plan benefits and medical center operations.
  • Knowledge of coding systems, including ICD and CPT/HCPCS.
  • Understanding of healthcare payment models.
  • Proficient in Microsoft Office Suite.
  • Excellent customer service skills.

Preferred Qualifications:

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

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