Continuum Care Support Specialist
2 weeks ago
The Continuum Care Coordinator plays a vital role in facilitating all non-clinical operations within the healthcare continuum. This position supports the daily functions of Case Managers and Physicians, 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 utilization management, continuing care services, and case management.
Key Responsibilities:- Facilitates non-clinical operations throughout the healthcare continuum.
- Assists in discharge planning for patients across various care settings.
- Handles incoming calls to address inquiries from patients, vendors, and healthcare providers, managing a high volume of calls daily.
- Operates effectively in a call-centric environment, meeting established performance metrics.
- Maintains productivity to fulfill the needs of patients and healthcare providers.
- Inputs authorization and referral data into necessary systems, ensuring accuracy in diagnoses, bed types, discharge dates, and other relevant information.
- Reviews and updates authorizations daily to ensure the accuracy of census reports and participates in case management rounds for necessary updates.
- Documents external medical services and processes referrals for all levels of care.
- Verifies eligibility and benefits for all admissions and conducts follow-ups as required.
- Determines admission status based on physician orders for retroactive admissions, processing authorizations for review.
- Coordinates data collection and reporting needs, providing timely analytics support.
- Collaborates with various organizational units and external facilities to gather and verify information, including working with claims and vendors to reconcile charges.
- Educates members, physicians, and hospitals on covered benefits and related inquiries.
- Assists members during the claims review process and coordinates both authorized and non-authorized claims reviews.
- Oversees transportation arrangements and authorization reviews for air and ground services.
- Coordinates durable medical equipment needs for members.
- Ensures the consistency and integrity of utilization tracking management systems.
- Schedules appointments for members and coordinates necessary care.
- Processes pended claims in the system, forwarding them to appropriate staff for investigation and resolution.
- Generates and distributes census reports for case rounds, attending meetings with healthcare staff and physicians.
- Prepares necessary documentation for referrals and places them in member charts as directed.
- Minimum of two (2) years of relevant experience in a healthcare setting.
- High School Diploma or General Education Development (GED) is required.
- Certification as a Professional Coder, Outpatient Coder, or Coding Specialist is required within six months of hire.
- Ability to apply critical thinking and analytical skills to data management.
- Strong communication skills, both written and verbal.
- Proficiency in tracking systems, spreadsheets, and computer operations.
- Familiarity with health plan benefits and medical center operations.
- Experience with data entry and knowledge of ICD and CPT/HCPCS coding.
- Understanding of healthcare payment systems.
- Proficient in using office software, including Microsoft Office Suite.
- Clinical background is advantageous.
- Certification in Medical Terminology is preferred.
- Bachelor's degree is desirable.
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