Salary: $15.00 /hour
SUTTER HEALTH IS HIRING!!!
MUST HAVE MEDICAL TERMINOLOGY, ANATOMY AND PHYSIOLOGY COURSES COMPLETED. – PLEASE STATE WITH YOUR RESUME!
The Care Coordination representative demonstrates the ability to read, comprehend, understand and interpret complex medical guidelines to determine if appropriate information has been provided in utilization reviews before transmission to external payers for review of medical necessity for Inpatient admission. The care coordination representative uses effective interpersonal skills in supporting the complex interactions involved in communicating with the Care Coordination staff, the payers, internal and external departments within the organization and other vendors.
- Transmission of utilization reviews to external payers
– Analyzes and interprets medical guidelines to determine if appropriate information has been provided in utilization reviews prior to transmission to commercial external payers
– Identifies utilization reviews with missing information or needing correction and escalates them to care coordination specialist, clinical support nurse or to care coordination supervisor
– Transmits completed and error-free utilization reviews to the correct payer
– Responds to payer requests through voicemail, secure email, regular mail, fax or phone calls and follow departmental escalation process to route requests to the appropriate level of authority
– Accurately document interactions and communication with payers and vendors using applicable systems
- Provide support for the care coordination department
– Receives sorts, files, and routes high volumes of mails, emails, and faxes from different types of vendors, analyzes and interprets the information and take appropriate actions including direct response to the requests or escalation to appropriate level of authority for resolution
– Provides support in recovery audit contractor (RAC) as directed by care coordination specialist, care coordination case manager or care coordination supervisor
– Provides support to care coordination specialist, care coordination case manager and care coordination supervisor in
troubleshooting variety of issues related to payer communication.
– Provides support in denial and authorization research, patient eligibility research and documentation of certified days in systems.
– Retrieves, interprets, and relays messages in a format that can be stored in a database for processing
- Promote customer service with internal and external customers
– Ability to listen, analyze and interpret customer needs and direct them appropriately
– Answers the department queue line and responds to customer needs in a timely and efficient manner by taking ownership
– Provide assistance to Care Coordination staff within the scope of the care coordination representative responsibility
– Clear verbal communication with internal and external departments
– Understands urgency and be able to utilize available resources to solve customer’s needs and/or escalate as needed
– Courteous and professional demeanor in order to de-escalate situations
– Provide information about department programs, functions, processes and services
- Compiles, produces, distribute operational reports
– Run daily, weekly, monthly and/or ad hoc reports for immediate distribution
– Create and completes template forms for various tasks
– Process high volume of data from spreadsheets or databases or any other formats and entering them into systems, databases and files
- Other Projects and duties as needed
– Provides assistance to the care coordination team in special projects
– Comfortable use of electronic applications such as: Midas, Epic, MS4, DI, Shipper, IDX, Ecin, Right fax, and other computer programs
– Ability to identify and report issues with applications and systems to the appropriate department
– Follows directions with flexibility as priorities may change based on business need identified by care coordination supervisor
– Maintains department files, reference materials and policy manuals
– Participates in process improvements projects