Torrance Memorial Medical Center
Location
Torrance, California
Salary
$49 - $82 / HOUR
Responsible for managing the intake of new and complex referrals for home health and hospice services. This includes coordinating patient services, verifying insurance coverage, and collaborating with case managers to expedite admissions.
Requires a college diploma in nursing and at least 3 years of experience in healthcare managed care, home health agencies, or case management.
Responsible for the intake of new and complex referrals to home health and hospice and coordinating services for referred patients Core Competencies Accepts referrals from hospitals, physician offices, SNFs and other community referral sources, obtains required orders for services and coordinates infusion products and DME/HME delivery
Pre-screens clients referred by physicians for hospice needs, eligibility, and homebound status, if appropriate
Evaluates patients referred to the Organization; identifies insurance coverage, negotiates payment or per diem rates; plans and coordinates referrals for hospice services.
Collaborates with the case manager to expedite discharges and screen admission requests..
Triages the needs of referred patients to assist scheduling for same day or within 48 hours of referral
Elevates issues as appropriate to the Director, Revenue Cycle.
Responds to voicemail and emails within 24 hours of receipt. Forwards patient complaints to the Lead Patient Account Representative or Director, Revenue Cycle, when appropriate.
Stays informed of updated insurance requirements and reimbursement practices
Maintains an advanced knowledge of insurance payor contracting as well as authorization requirements by payor. Maintains knowledge of the methods of payment, pricing and insurance billing.
Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions.
Develops and maintains cooperative relationships with hospital personnel, physicians, suppliers and insurance case managers. Arranges for alternate hospice providers utilizing Letter of Agreement for capitated patients out of the service area. Sets realistic expectations with patients/families regarding hospice service Education Degree Program College Diploma Nursing Experience Number of Years Experience Type of Experience 3 Healthcare managed care, home health agency or case management Compensation Range $48.77 - $81.51 / Hour
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