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Continuum Care Specialist

2 months ago

Atlanta, Georgia, United States Kaiser Permanente Full time
Job Overview:

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

Key Responsibilities:
  • Assist in all non-clinical operations throughout the care continuum.
  • Support discharge planning processes for patients.
  • Handle incoming calls to address inquiries from patients, vendors, and healthcare providers, managing a significant volume of calls daily.
  • Thrive in a call-centric environment, meeting established performance metrics.
  • Work efficiently in a productivity-driven setting to meet the needs of patients and healthcare providers.
  • Input authorization and referral data into necessary systems, ensuring accurate admission, principal, and discharge diagnoses.
  • Maintain the integrity of Tapestry Census Reports by reviewing and updating authorizations regularly.
  • Document external medical services and manage referrals across all levels of care.
  • Verify eligibility and benefits for all admissions, conducting follow-ups as required.
  • Determine admission status based on physician orders and manage authorizations accordingly.
  • Coordinate data collection and reporting processes, providing timely analytics support.
  • Collaborate with various departments and external facilities to gather and verify necessary information.
  • Educate members, physicians, and hospitals regarding covered benefits and related inquiries.
  • Assist members during the claims review process, managing both authorized and non-authorized claims.
  • Oversee transportation coordination and authorization reviews for air and ground services.
  • Manage durable medical equipment requests for patients.
  • Ensure the consistency and accuracy of utilization tracking management systems.
  • Schedule patient appointments and coordinate care as necessary.
  • Process pended claims in Tapestry, forwarding them to the appropriate staff for resolution.
  • Prepare and distribute Tapestry census reports for case rounds.
  • Compile necessary documentation from patient charts for referrals as requested.
Qualifications:
Experience
  • At least two (2) years of relevant experience.
Education
  • High School Diploma or equivalent required.
Certification
  • Certification as a Professional Coder, Outpatient Coder, or Coding Specialist within six months of hire.
Additional Skills:
  • Strong analytical and problem-solving abilities.
  • Excellent communication skills, both written and verbal.
  • Proficient in data tracking and spreadsheet management.
  • Familiarity with health plan benefits and medical center operations.
  • Experience with ICD and CPT/HCPCS coding.
  • Knowledge of healthcare payment systems.
  • Competence in using office technology, including computers and fax machines.
  • Exceptional customer service skills.
  • Proficient in Microsoft Office Suite.
Preferred Qualifications:
  • Clinical background is advantageous.
  • Certification in Medical Terminology is preferred.
  • Bachelor's degree is a plus.