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Continuum Care Specialist

2 months ago

Norcross, Georgia, United States HealthEcareers - Client Full time
Job Overview:

The Continuum Care Coordinator plays a vital role in managing non-clinical operations within the healthcare continuum. This position is essential for assisting Case Managers and Physicians in their daily tasks. The Coordinator ensures the accuracy of data related to both inpatient and outpatient services, facilitating effective utilization management and continuity of care.

Key Responsibilities:
  • Assist in all non-clinical operations throughout the healthcare continuum.
  • Support discharge planning processes for patients across various care settings.
  • Handle incoming calls, addressing inquiries from patients, vendors, and healthcare providers, managing a high volume of calls daily.
  • Thrive in a call-centric environment, meeting established performance metrics.
  • Work effectively in a productivity-driven setting to fulfill the needs of patients and healthcare providers.
  • Input authorization and referral data into necessary systems, ensuring accuracy in diagnoses, bed types, discharge dates, and other critical information.
  • Maintain the integrity of Tapestry Census Reports by regularly reviewing and updating authorizations and participating in case management discussions.
  • Document external medical services and manage referrals in Tapestry for all levels of care.
  • Verify eligibility and benefits for all admissions and conduct follow-ups at designated intervals.
  • Determine admission status based on physician orders for retroactive weekend admissions, processing authorizations for review.
  • Coordinate data collection and reporting needs, addressing any data processing challenges while providing timely utilization data and analytical support.
  • Collaborate with various organizational units and external facilities to gather, verify, and share information, including working with claims departments and vendors.
  • Educate members, physicians, and hospitals about covered benefits and related topics.
  • Assist members during the claims review process, coordinating both authorized and non-authorized claims reviews.
  • Oversee air and ground transportation coordination and authorization reviews for these services.
  • Manage durable medical equipment needs for members.
  • Ensure the consistency and integrity of all relevant utilization tracking systems.
  • Schedule appointments for members and coordinate necessary care.
  • Process pended claims in Tapestry, forwarding them to the appropriate staff for investigation as needed.
  • Prepare and distribute Tapestry census reports for case rounds, participating in discussions with Continuum staff and Physicians.
  • Compile necessary sections of member charts for referrals to various levels of care as requested.
Qualifications:
  • Minimum of two (2) years of relevant experience in a healthcare setting.
Education:
  • High School Diploma or General Education Development (GED) is required.
Licensure and Certification:
  • Certification as a Professional Coder, Outpatient Coder, or Coding Specialist within six months of hire.
Additional Skills:
  • Ability to apply critical thinking and analytical skills to both inpatient and outpatient data.
  • Strong written and verbal communication skills.
  • Proficiency in tracking systems, spreadsheets, and computer systems.
  • Familiarity with health plan benefits and medical center operations.
  • Experience with data entry and knowledge of ICD, CPT, and HCPCS coding.
  • Understanding of healthcare payment mechanisms.
  • Functional knowledge of office equipment and software, including Microsoft Office Suite.
  • Excellent customer service abilities.
Preferred Qualifications:
  • Clinical background is preferred.
  • Certification in Medical Terminology is a plus.
  • Bachelor's degree is preferred.