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Are you an experienced Registered Nurse with a passion for shaping the future of healthcare? Our Post-Acute Care team at CareCentrix is committed to making the home the center of patient care.
As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. Responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site initial face to face outreach with patients to introduce the Post-Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. You will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.
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This position receives/responds to incoming calls from referral sources/patients and communicates with providers for CareCentrix and contacts referral sources to advise them of referral status. Reviews utilization information concerning patient care for CareCentrix and matches those needs to available care options within the reauthorization guidelines provided by CareCentrix and patients’ health care. Assists the Supervisor and Manager with coaching, training, call monitoring, reports and mentoring of new associates. Acts as a clinical resource to department specialists, providing expertise and clinical knowledge. Negotiates with providers when needed and stay within the guidelines. Performs Utilization Management and participates in performance improvement activities (specific measurement for contracts). Works under moderate supervision.
- Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
- Works collaboratively with Utilization Management Medical Director, Manger, and Supervisor(s).
- Assists Supervisor/Manager with coaching, training, call monitoring, reports and mentoring of new associates.
- Assigns and prioritizes clinical cases for team member review based upon clinical urgency and turnaround times.
- Acts as a clinical resource for unlicensed Utilization Review Care Coordinators, providing clinical expertise and helping to clarify referral source directives. Receives/responds to requests from unlicensed staff regarding scripted clinical questions and issues.
- Makes on-going authorization decisions for health plans for which CareCentrix manages the reauthorization responsibilities. Issues service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
- Ability to negotiate with providers when needed and stay within the guidelines.
- Performs an evaluation of referral appropriateness for CareCentrix services.
- Researches/identifies all potential payer sources and determines the primary payer.
- Receives/responds to incoming calls from referral sources/ patients, exchanges information in order to identify the patient’s needs and assist in determining the Company's ability to meet them.
- Documents the outcome of calls and referral acceptance in an automated manner.
- Contacts referral sources to advise them of referral status. Relays referral and utilization information to the clinical team who will deliver the services requested.
- Access payer fact sheets to determine if the terms of the contract are covered. Works with the Patient Registration team, contracted providers and patients to identify potential solutions as clinical problems are identified with payer sources.
- Communicates customer service/provider issues to supervisor for logging and resolution.
- Participates in and contributes to ongoing utilization management activities and quality audits. Ensures the collection of data for improvement analysis and prepares reports as requested.
- Assists team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
- Participates in implementing / maintaining operational processes to ensure compliance to Company.
- Participates in special projects and performs other duties as assigned.
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Responds to patient/financial responsible party calls effectively and provides exemplary customer service. Identify callers' needs; educate them on CareCentrix role in their care. Determines the acceptance of patient’s financial responsibility through claim research, plans, eligibility, notes, etc.; goal to resolve patient’s account. Identifies and escalates patient issues and concerns to the appropriate senior. Works under general supervision. Guides collectors in their performance of invoice processing activities to ensure receivables are reimbursed in an accurate and timely basis. Works directly with the payer, internal and external customers and other contract clients towards efficient and effective collection results. Works under moderate supervision.
PRIMARY RESPONSIBILITIES
Collector
• Ensures the coordination of invoice activities leading to timely reimbursement of receivables using available resources including databases, internet, and telephone.
• Researches and resolves denials received that have not passed payer edits and may lead to a final appeal of denied services. Requires knowledge of a variety of system applications both internal and external. Determines and initiates action to resolve rejected invoices, prepares payer corrections, and/or appeals using electronic and paper processes.
• Provides guidance, assistance, education, and communications with internal and external customers related to insurance and government payers claims processing protocols.
• Utilizes various resources to determine patient’s eligibility, benefits, and health plan confirmation. Including online payer databases, CareCentrix Eligibility platforms, and medical records that may result in provider or payer recoup/rejection activity.
• Oversees accounts receivable adjustments to resolve overpayments and payment rejections according to standard operating procedures. Analyzes and clears payment variances. May prepare adjusted and corrected bills or adjust accounts receivable entries in accordance with existing operating procedures. May include the use of special reporting.
• Evaluates, analyzes and monitors the processing of invoices and on-line notes, utilizing a Windows based data processing system. Monitors payer responses, using Microsoft Excel, Microsoft Access and other software as necessary to ensure prompt payment.
• Contacts providers, physicians, and/or patients to retrieve appropriate medical documentation to substantiate services provided and engage them in assisting CareCentrix in collecting for the payer.
• Provide payers with detailed itemization of services performed to ensure timely reimbursement.
Review EOPs/EOMBs/EOBs for accuracy of patient responsibility.
• Provide input on accounts receivable process improvements and assisting in their implementation.
• Prepares Ad Hoc financial reports for management to use in the evaluation of accounts receivable performance.
• Participates in teleconferences covering a wide range of topics that enables the NBC to effectively collect account receivables.
• Assist Lead Collector with training of newly hired associates and re-education of collection teams as necessary.
• Acts as an information resource for hard to collect accounts and a “grey area” subject expert.
Ensures the coordination of special handling or reconciliation of spreadsheets for national payers.
• Monitors team results to ensure they are aligned with departmental goals.
• Works with internal customers to identify issues which may result in new enhancements or platforms as necessary.
• Assures the completion and coordination of work in an associate’s absence, or as needed to maintain departmental standards.
• Participates in special projects and performs other duties as assigned.
Patient Account Specialist
• Researches, resolves, and documents patient inbound and outbound calls involving a wide range of issues utilizing multiple information systems. This includes communications with internal business centers and external customers. Assures customer agreement by summarizing and closing each call appropriately.
• Investigates payment status and determines ultimate patient financial responsibility. Collect outstanding balance, offer patient assistance with financial responsibility through various financial options.
• Identifies overpayments, processes refunds, adjustments, and appeals as necessary. Analyzes and resolves payment variances, which may involve preparation of adjusted and corrected bills, or adjusting accounts receivable entries in accordance with existing operating procedures. This may include the use of special reporting.
• Minimizes patient dissatisfaction by listening attentively, maintaining a professional tone, and acknowledging their concerns. Escalates patient issues and concerns to the appropriate senior.
• Works with internal and external customers to obtain appropriate medical documentation, work orders, proof of delivery, or other documentation necessary to resolve open account issues.
• Reviews payer payment explanation for accuracy of patient responsibility.
• Exercises good judgment, interpret data, and remains knowledgeable in details of all related CareCentrix contracts, policies and procedures. Participates in process improvement initiatives; maintains teamwork, customer service production and quality standards to assure timely, efficient and accurate call resolution.
• Maintain patient confidentiality and data integrity in accordance with Health Information Portability Accountability Act (HIPAA), and company policies and procedures.
• Sends patient necessary documentation required to complete the payment arrangement process. Prepares payment plan agreements or other correspondence; including requests for secondary payers or Medicare/Medicaid verification or other documentation necessary to resolve open account issues. Assures patients return documentation or signed payment agreements.
• Takes appropriate action when patient requests assistance in reconciling their financial responsibility, including proper follow up.
• Participates in special projects and performs other duties as assigned.
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If you have customer service experience and want to make a patient's life better and easier by healing at home, this is a great opportunity for you!
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The Post-Acute Care Program assists with reducing hospital readmissions of clinically complex patients. The program couples patient education/coaching with Home Health interventions to assist a patient’s transition home after a hospital stay. Staff works directly with patients in transitioning from hospital to home with a focus on short term self-recovery in the home and long term ongoing care management of their healthcare. Assess patients care needs through assessments that are completed in home and/or telephonically, treatment plan creation to mitigate care gaps, facilitate in home health care services to accomplish the treatment plan patient goals, patient education/coaching along with adherence/compliance monitoring.
This position functions as the Supervisor of the Post-Acute Care team and primary point of contact for day to day clinical questions, concerns from internal and external clients and provides team leadership and guidance regarding patient centered interventions. Assists in development of Post-Acute Care training, job aids and tools and desk level procedures. Provides clinical oversight for the PAC Nurse Liasions.
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Do you have the passion to make an impact on people’s lives? Then come join our team! CareCentrix is committed to making the home the center of patient care.
As a Healthcare Customer Service Expert in our Staffing Team, you make a difference every time you schedule home healthcare services for a patient. You will have full accountability and ownership of cases ensuring patient discharges timely, or if already at home, care begins per the physician's request. Prioritization and organization skills are key to being successful in this role.
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Do you have the passion to make an impact on people’s lives? Then come join our team! CareCentrix is committed to making the home the center of patient care.
As a Healthcare Customer Service Expert in our Staffing Team, you make a difference every time you schedule home healthcare services for a patient. You will have full accountability and ownership of cases ensuring patient discharges timely, or if already at home, care begins per the physician's request. Prioritization and organization skills are key to being successful in this role.
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Do you have the passion to make an impact on people’s lives? Then come join our team! CareCentrix is committed to making the home the center of patient care.
As a Healthcare Customer Service Expert in our Staffing Team, you make a difference every time you schedule home healthcare services for a patient. You will have full accountability and ownership of cases ensuring patient discharges timely, or if already at home, care begins per the physician's request. Prioritization and organization skills are key to being successful in this role.
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As a Clinical Reviewer, you will be responsible for the review of clinical information for service requests received and render a medical necessity approval or recommended denial to the Medical Director. You will evaluate information concerning patient care and match those needs with available care options, consistent with CareCentrix guidelines and specific plan payer criteria. You will review referrals for medical necessity and determine approval or elevation to the Medical Director. You will own the case from point of referral to the recommendation for denial, or approval decision. If a request is to be denied, you will complete the denial process in collaboration with the Medical Director; if a request is to be authorized, it will then be sent onto the staffing department for completion when appropriate.
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If you have customer service experience and want to make a patient's life better and easier by healing at home, this is a great opportunity for you!
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Are you an experienced Registered Nurse with a passion for shaping the future of healthcare? Our Post-Acute Care team at CareCentrix is committed to making the home the center of patient care.
As a Nurse Liaison you will be an expert in resource management, a master of utilization review and a compassionate partner for patients and their support network. Responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in person, on site initial face to face outreach with patients to introduce the Post-Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. You will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.
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As a Clinical Reviewer, you will be responsible for the review of clinical information for service requests received and render a medical necessity approval or recommended denial to the Medical Director. You will evaluate information concerning patient care and match those needs with available care options, consistent with CareCentrix guidelines and specific plan payer criteria. You will review referrals for medical necessity and determine approval or elevation to the Medical Director. You will own the case from point of referral to the recommendation for denial, or approval decision. If a request is to be denied, you will complete the denial process in collaboration with the Medical Director; if a request is to be authorized, it will then be sent onto the staffing department for completion when appropriate.
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Facilitates new hire, customer service, systems, business processes, and new initiative training for all clinical operational business unit. Works closely with the business to ensure that associates receive effective on-the-job training support. Position requires facilitation skills and the ability to provide coaching and feedback.
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Reviews and investigates claims and makes claim payment determinations.
Successfully processes claims into CCX systems and matches claims data with the appropriate authorizations as necessary.
Determines correct claims payment or denial through the use of job aids, DLPs and basic claims training.
Identifies and evaluates questionable claims and authorizations or system issues as appropriate.
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This leadership position will develop and manage market specific relationships with acute and post-acute facilities, home health agencies, physician groups, accountable care organizations (ACOs) and integrated delivery networks (IDNs). As the Director of Market Engagement you will evaluate the market dynamics, communicate with market leadership and collaborate with hospitals, skilled nursing facilities, home health agencies and at risk providers to influence key value drivers and improve the delivery of post-acute care. The Director monitors key metrics and supports acute and post-acute initiatives that will improve outcomes, enhance provider and patient satisfaction and achieve overall program performance targets. You will also assist in identifying strategic relationships and solutions, alternative PAC delivery models, and other activities focused on creating value for the CareCentrix payor and provider community.
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Come make a difference with a growing organization that is helping to shape the future of healthcare! CareCenrix is committed to making the home the center of patient care.
This position will be part of the Linux Administration team responsible for managing our middleware tier on RedHat Linux in a virtualized environment utilizing VMware. This position will work closely with other teams – Windows, Network, VMWare, Database and Security to maintain and seek ways to advance capabilities including expanding into the cloud infrastructure.
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The incumbent in this position acts as a subject matter expert (SME) in assigned unit, fields questions from staff, is able to provide appropriate issue resolution and escalation when needed, and assigns work/directs workflows for staff. Assists Supervisor/Manager with coaching, on-the-job training, monitoring work, mentoring new associates and driving results. This position may also serve as a back-up in production. Works with other departments to identify areas of opportunity/performance improvement and recommend solutions.
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This leadership position will develop and manage market specific relationships with acute and post-acute facilities, home health agencies, physician groups, accountable care organizations (ACOs) and integrated delivery networks (IDNs). As the Director of Market Engagement you will evaluate the market dynamics, communicate with market leadership and collaborate with hospitals, skilled nursing facilities, home health agencies and at risk providers to influence key value drivers and improve the delivery of post-acute care. The Director monitors key metrics and supports acute and post-acute initiatives that will improve outcomes, enhance provider and patient satisfaction and achieve overall program performance targets. You will also assist in identifying strategic relationships and solutions, alternative PAC delivery models, and other activities focused on creating value for the CareCentrix payor and provider community.
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Come join a dynamic, growing team in an innovative, game-changing, healthcare organization! CareCentrix is committed to making the home the center of patient care.
As a Business Intelligence Developer, you will be responsible for pulling and aggregating data from multiple disparate systems, building and supporting enterprise level BI and Analytic solutions that will enable business users to make informed business decisions and help foster a data driven culture. The individual will work closely with business stakeholders to gather requirements, consulting as the data subject matter expert, design and develop reports and dashboards, create and execute ad-hoc queries against CareCentrix’s data warehouse and operational systems. This individual is specifically being brought on to help with enhancements, new reports, and functionalities, as well as issues and requests received in the form of tickets. In this role, you should have a background in data and analytics, be an excellent communicator and be passionate about what you do.
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Post-Acute Care (PAC) Program 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 CareCentrix care coordination team.
POSITION SUMMARY
The Nurse Liaison is responsible for an assigned caseload at acute and post-acute care facilities. The Nurse Liaison will conduct in person, on site initial face to face outreach with patients to introduce the Post Acute program, gather patient demographics and collaborate with hospital clinicians, patient and family to develop a discharge path of care. The Nurse Liaison will coordinate post-acute care services for the patient and collaborate with Post Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.