Discharge Assistant
5 days ago
As a Discharge Assistant at Carilion Clinic, you will play a vital role in ensuring a smooth transition of patients from our healthcare facilities to their homes or other care settings. Your primary responsibility will be to coordinate and facilitate the discharge process, working closely with our medical and nursing staff, payors, and other stakeholders to ensure that all necessary steps are taken to ensure a safe and timely discharge.
Key Responsibilities:
Coordinate and schedule peer-to-peer conversations between Carilion providers and payor liaisons to gather required clinical and demographic data for UM/Appeals cases.
Gather and disseminate required clinical and demographic data to appropriate recipients, including payors and UM team members.
Supply payor information to the UM team and document actions taken.
Prioritize work to maintain workflow functions as needed, including fielding faxes, voicemails, written correspondences, categorizing, and disseminating mail.
Arrange and document P2P requests, post P2P determinations, denial, and approval information from payors, and provide missing or updated demographical/clinical information needed for authorization determinations.
Communicate with payors, Carilion billing department, and UM team for appeals case submissions, and explore inquiries regarding benefits, coverage, and insurance questions.
Assist Central Resource Center (CRC) staff with certain workflows, such as regulatory letters and Virginia MLTSS (UAI) approval process as needed.
Maintain databases and spreadsheet files, ensuring accuracy, production, and distribution, and manage Epic work queues with appeals, denials, and P2Ps and track related data.
Research and resolve issues and concerns to ensure a timely turnaround and facilitate throughput.
Support regulatory tasks that are federally mandated, such as the Medicare Important Message (IM), Lifetime Reserve (LTR) Day, and Status Change letters.
Aid in the completion of demographic information to facilitate delivery of in-person letters to patients (IM, observation to IP, LTR, and Code 44, etc.).
Collaborate with the UM team and Carilion billing to verify and add LTR day information to letters for delivery.
Receive Notice of Medicare Non-Coverage (NOMNC) letters for patients that are in swing beds and disseminate to all Care Management team members in a timely manner.
Document delivery in patient's electronic medical record and notify billing department as appropriate.
Provide letter delivery at regional facilities as needed.
Process health plan-specific referral requirements, including prior authorizations, and assist with denial/appeal resolutions and P2P initiations related to admission and throughput needs.
Serve as a resource/liaison to payors, billing, staff, patients, and providers, and answer phone calls regarding pricing, benefits, coverage, approvals, denials, and insurance questions.
Requirements:
Associate degree or equivalent combination of education or equivalent 2 years of experience.
Two years of experience in data collection and analysis and/or advanced secretarial support required.
Experience in emergency services or healthcare practice setting preferred.
Virginia MLTSS (UAI) Certification required to complete orientation and must be maintained throughout employment.
Advanced computer skills with knowledge of a variety of software programs, including Microsoft Word, Excel, Access, word processing, spreadsheets, and presentation or database software.
Excellent communications and organizational skills required.
About Carilion Clinic:
Carilion Clinic is a not-for-profit, mission-driven health system built on progress and partnerships. We are a courageous team that is always learning, never discouraged, and forever curious. Our organization is headquartered in Roanoke, Va., and we offer a robust system of award-winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
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