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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 pivotal role in managing non-clinical operations within 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 tasked with overseeing data entry, analysis, and reporting for utilization management, continuing care services, and case management.

Key Responsibilities:
  • Facilitates non-clinical operations across the healthcare continuum.
  • Assists in discharge planning for patients throughout the care continuum.
  • 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 meet 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 precision of Tapestry Census Reports, participating in case management rounds as needed.
  • Documents external medical services and processes referrals into Tapestry for all care levels.
  • Verifies eligibility and benefits for all admissions and regularly thereafter.
  • Determines admission status based on physician orders for retro admissions, entering necessary authorizations for review.
  • Coordinates data collection and reporting processes, providing timely utilization data and analytical support.
  • Collaborates with various organizational units and external facilities to obtain and verify necessary information.
  • Educates members, physicians, and hospitals on covered benefits and related topics.
  • Assists members during the claims review process, coordinating both authorized and non-authorized claims reviews.
  • Oversees transportation arrangements and authorization reviews for air and ground services.
  • Coordinates durable medical equipment needs for patients.
  • Ensures the consistency and integrity of utilization tracking management systems.
  • Schedules patient appointments and coordinates care as necessary.
  • Processes pended claims in Tapestry, forwarding them to the appropriate staff for investigation.
  • Prepares and distributes Tapestry census reports for case rounds, attending rounds with healthcare staff.
  • Copies necessary sections of patient charts for referrals to various care levels 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:
  • Must obtain Certified Professional Coder, Certified Outpatient Coder, or Certified Coding Specialist certification within six months of hire.
Additional Skills:
  • Strong analytical and communication skills, both written and verbal.
  • Proficient in data entry and familiar with tracking and spreadsheet software.
  • Knowledge of health plan benefits and medical center operations.
  • Understanding of healthcare payment mechanisms.
  • Competent in using Microsoft Office Suite (Word, Excel, PowerPoint, etc.).
  • Excellent customer service abilities.
Preferred Qualifications:
  • Clinical background is preferred.
  • Medical Terminology Certification is a plus.
  • Bachelor's degree is preferred.