Company :

Allegheny Health Network

Job Description :

GENERAL OVERVIEW

Coordinates the clerical and administrative processes of utilization management and discharge arrangements. Completes any other tasks within department guidelines requested by the Care Management Coordinators and Social Workers.

ESSENTIAL RESPONSIBILITIES

• Assists with utilization review by identifying patients to be completed and/or closed out; ensures timely transfer of pertinent patient information to third party payers; follows up with third party payers as needed; assists in the acquisition of authorizations for acute and post-acute services; appeal and denial process as needed. (35%)

• Supports discharge plan implementation under direction of the care coordinator and social worker, which may include but not limited to: faxing to payers/post-acute providers; calling vendors, physician offices, clinics, etc.; arranging for durable medical equipment; facilitating transfers and transportation; coordinating and scheduling home health needs; identifying community resources; completing appropriate discharge documentation; identifying primary care physicians and scheduling PCP/specialty appointments as needed; updating patient demographic/billing data; assisting with placement process. (55%)

• Collects/enters data as directed and performs other administrative duties as needed. (5%)

• Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies. (5%)

• Performs other duties as assigned or required.

QUALIFICATIONS

Minimum

• At least 3 years of relevant experience, proficient computer skills with experience in: Microsoft office, internet navigation, clinically- based software, and financially-based software.

• Knowledge of medical terminology required.

• Requires interpersonal skills, communication skills (both personal and telephonic), and the ability to work without supervision when necessary.

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Req ID: J245950