Post-Acute Care is an end-to-end post-acute offering that manages up to 90-day episodes of care, beginning prior to the patient’s discharge from the hospital, or for elective surgical cases, outreach begins prior to hospitalization. The program optimizes our home-based network, identifies the likely best site-of-care for the patient, manages length of stay (LOS) if a Skilled Nursing Facility (SNF) is appropriate, and reduces hospital readmissions. Our program also coordinates all of the services required for a patient to transition to their home faster and safer, via our network of home health, durable medical equipment and home infusion providers, all of whom are supported by our Post-Acute Care coordination team.
This position incorporates all Care Coordinator functions within the CareCentrix Post-Acute Care Program including collecting and verifying clinical and demographic information, hospital discharge dates, initial authorizations, staffing of services with HHA and patient / provider education for Post-Acute Care Program. The Post-Acute Care Coordinator educates and gathers information using scripted clinical and non-clinical questions and is able to provide appropriate issue resolution and/or escalation when needed. The position works under moderate supervision, with clinical oversight and input.
• Coordinates the setup of cases in different CareCentrix applications for HomeSTAR Program referral process .
• Initiates outbound calls to hospitals, discharge planners, physicians, and home health agencies providing education regarding the benefits of the HomeSTAR Program.
• Determine discharge status of referred patients by contacting discharge hospitals. Researches and determines location and status of referred patients.
• Staffs HomeSTAR referrals with HomeSTAR designated agencies, identifies if a new HomeSTAR agency is needed and alerts network operations of recommended addition if applicable.
• Interacts with physician offices to obtain home health orders for HomeSTAR services, monitors compliance of documentation submission and coordinates the retrieval of home health agency nurse documentation and surveys.
• Participates in and contributes to performance and process improvement activities.
• Involved in the collection, verification and confirmation of non-clinical information. Gathers structured clinical documentation. Is able to provide appropriate non-clinical issue resolution and escalation of issues when needed.
• Receives/responds to incoming calls from referral sources/potential patients, exchanges information to identify the patient’s needs and determines the Company's ability to meet them. Records the outcome of calls in the proper screen.
• Completes initial case set up process and consults applicable Payer Fact Sheets.
• Contacts health plans or payors to gather policy benefits/limitations and completes eligibility and benefits verification to ensure services provided will be covered by the carrier. (e.g., deductible amounts, co-payments, effective date, pre-existing clauses, levels of care, authorization, visit limitations, documentation required to process claims, etc.). Documents all communications and decisions into a computer database or on a manual form.
• Access payer fact sheets to determine if the terms of the contract are covered. Works with contracted providers and patients to identify potential solutions as problems are identified with payer sources.
• Contacts referral sources to advise them of referral status. Relays referral and utilization information to the appropriate HomeSTAR team member.
• Understands that timely and accurate documentation is critical to the success of CareCentrix.
• Coordinates provider service authorizations for immediate referral resolution.
• Ability to negotiate with providers when needed and stay within the guidelines.
• Must be committed to quality and high standards. Be able to provide issue resolution and escalation when appropriate.
• Works closely with health plans/payers and maintains strong business relationships.
• Participates in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
• Participates in special projects and performs other duties as assigned.
• Must perform other duties as required or assigned.
• High School Diploma or the equivalent plus a minimum of one year medical terminology or medical services experience required.
• Must have knowledge of basic spreadsheet / word processing / data entry skills.
• Experience in a call center environment preferred. Knowledge of Utilization Management and URAC standards preferred.
• This position requires excellent communication, customer service and problem solving skills, as well as the ability to effectively interact with all levels of management and a highly diverse clientele.
• Must have strong organizational skills and be able to effectively manage and prioritize tasks.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.