Job Description

This is an exciting opportunity to join the Primary Children’s Outpatient Specialty team! The primary focus of this role will be to assess families for social drivers of health needs and then connect them with resources. This role will supplement the work of the social work care manager in the holistic care of the pediatric patient. This role will be primarily on-site in order to interact with patients/families. Serves as the primary contact with payers, receiving and prioritizing requests and sending clinical information for authorization of services based on contractual requirements. Promptly communicates utilization review needs, days authorized, denials, and other communication from the payers to care managers and physician advisors. Collaborates with the revenue cycle staff and others to research payment sources. Maintains a current list of contractual requirements and contact information by payer (as communicated by payer contracting). Promptly distributes new information and communicates changes to care management staff and leaders. Requests and retrieves medical records from the Health Information Management for retrospective utilization or quality assurance review. Delivers routine regulatory notices to patients in the required timeframe (i.e. 'Follow-Up Important Message from Medicare' at least one day before the patient's expected discharge date). Performs a variety of specific clerical tasks to support care management services (i.e. prepares and prints reports; prioritizes and schedules appointments; distributes and/or communicates requests; retrieves phone; fax, email, and other messages and/or mail; scans and copies documents as needed). Supports advanced care planning by delivering advance directive information and notarizes documents upon request. Supports a compliant patient choice process by ensuring online provider lists are current in all systems, distributes provider list to patients/families as instructed, prior to patient choice consult performed by the care manager/social worker. Provides support for transition planning (i.e. prepares transfer packets for transition to post-acute/community-based facility or services; ensures resources and documents are routinely updated in the Integrated Care Management website; arranges transportation, confirms arrangements; communicates with the patient/family and next service providers). Consistently documents all communication, actions, and information. Promptly reports issues and concerns to the departmental chain-of-command. Assists with special programs including data collection for process improvement projects. Minimum Qualifications: Two years of healthcare experience. Advanced computer skills (i.e. developing spreadsheets, creating charts and graphs, word processing, process flows, complex formatting, data manipulation, creating and running reports, creating presentations, and using multimedia content). Two years of experience working in an office setting, working in a clerical position with keyboarding and data entry responsibilities, or working in customer service. Experience coordinating projects. Demonstrated interpersonal verbal and written communication skills including being proficient in spelling, punctuation, grammar, and other English language skills. Demonstrated basic math skills. Preferred Qualifications: Licensure: LPN; Associate Degree RN; BSW. College courses related to healthcare, business, and/or or computer/information systems. 2 years of experience working in a clinical healthcare setting. Medical terminology experience. Medical transcription experience. Leadership experience (i.e. providing training to others on their job duties, coordinating the work of others, coordinating projects, acting as a team lead, and directly supervising others). Physical Requirements: Interact with others requiring employee to verbally communicate as well as hear and understand spoken information. Operate computers, telephones, office equipment, including manipulating paper requiring the ability to move fingers and hands. See and read computer monitors and documents. Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

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