Patient Care Service Liaison
2 weeks ago
Key Responsibilities:
Assesses home medical equipment (HME) referrals and service requests to facilitate a seamless transition for patients from healthcare facilities to their residences, ensuring that patient safety and insurance benefits are maximized.
Acts as an advocate for patients, serving as a point of contact to clarify prescription orders, hospital discharge processes, and home care initiation, along with insurance coverage details.
Reviews service requests against organizational acceptance criteria and scrutinizes medical documentation to confirm compliance with payer coverage requirements.
Confirms patient insurance benefits and eligibility, reaching out to insurance providers to secure necessary prior authorizations and ascertain patient co-insurance obligations.
Guides healthcare providers on resolving documentation or medical management discrepancies when the documentation fails to demonstrate medical necessity or payer coverage criteria.
Identifies potential risk factors and collaborates with patients, healthcare providers, hospital personnel, and other care team members to ensure issues are resolved and patient safety is prioritized.
Coordinates the timely delivery of services with distribution operations and the patient.
Delivers exceptional customer service to all stakeholders, including patients, healthcare providers, referral sources, and colleagues within Advocate Health and external partners.
This role necessitates responding to client inquiries and concerns with professionalism and courtesy, ensuring follow-through to achieve satisfactory resolutions.
Maintains diligence in verifying that current and accurate authorizations are in place for all managed care clients to meet their needs and enhance operational efficiency across Advocate Health departments.
Follows established processes to ensure quality customer service, including electronic referrals, HME coding, pickups, and faxing.
Exhibits flexibility in taking on additional responsibilities to assist in resolving customer issues and fulfilling other business requirements.
Demonstrates proficiency in utilizing computerized resources and data entry systems for the effective processing and qualification of patients with HME needs.
Monitors and manages all necessary insurance verification reports for assigned product lines and payors, compiling and submitting data to management as required.
Identifies, investigates, and verifies reimbursement sources, making informed recommendations based on gathered information.
The team member will gather and document payer eligibility information for each new referral, service addition, and re-admission, determining if payer coverage criteria are met for services or equipment.
They will also evaluate potential third-party liability cases to identify the primary payer and communicate the relevant billing requirements to the patient accounts team and operations.
Additional responsibilities include liaising with referral sources regarding any intermittent services the patient may require and suggesting complementary items for the ordered equipment to enhance patient care.
Provides pricing information to clarify financial responsibilities to patients, assessing their ability to pay and negotiating payment plans while evaluating their financial risk at the time of referral.
If necessary, recommends appropriate actions and informs the patient and/or family of the anticipated financial obligations at the onset of care.
Participates in initiatives aimed at performance improvement and patient satisfaction, serving as a member of departmental or system performance or process improvement groups as appropriate.
Collaborates with management to implement changes and identify opportunities for enhancement.
Continuously updates knowledge regarding Medicare, Medicaid, HMO, and managed care coverage requirements and guidelines, which are complex and continually evolving.
Licensure, Registration, and/or Certification Required:
None Required.
Education Required:
High School Graduate.
Experience Required:
Typically requires 5 years of experience in medical data entry, claims processing, HME business operations, home care, insurance verification, customer service in home care, or other healthcare-related roles.
Knowledge, Skills & Abilities Required:
Regularly interacts with representatives of third-party payers
Maintains a wide range of contacts with hospitals, long-term care facilities, rehabilitation and therapy centers, physician offices, case managers, utilization review managers, patients, and their families.
Communication is required in both verbal and written forms.Determines the acceptance of patients with varying financial risks and effectively seeks out necessary resources.
Prioritizes insurance verification and prior authorization to meet departmental goals and objectives.
Monitors all managed care patients' supply orders and re-orders to ensure that adequate and current authorizations are recorded in the database, facilitating prompt reimbursement.
Troubleshoots equipment issues and seeks further assistance when necessary.Handles confidential information for every client.
Operates under tight deadlines to verify insurance benefits prior to equipment delivery and to enter referral information accurately for delivery tickets with the appropriate qualifying diagnoses for each ordered item.
Manages a high volume of daily incoming and outgoing phone calls and documents, ensuring timely and accurate processing. The work environment is fast-paced, requiring strong data entry and communication skills.
Physical Requirements and Working Conditions:
Work is performed in an office setting.
Must be able to sit, stand, and walk for extended periods.
Requires physical agility to navigate confined spaces, including bending, kneeling, squatting, and occasionally reaching overhead.
Must be capable of typing, writing, and data entry for prolonged durations.Occasional lifting of up to 10 lbs. is required.
Operates all necessary equipment to perform job functions.
This job description outlines the general nature and level of work expected of the incumbent.
It is not intended to be an exhaustive list of activities, duties, or responsibilities required of the incumbent.
The incumbent may be required to perform other related duties.#J-18808-Ljbffr
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