Care Coordination Specialist

Hackensack Meridian Health•North Bergen, NJ

1d•Onsite

About The Position

The Care Coordination Specialist performs selected services and functions related Transitions of Care & Utilization Management, including insurance authorization, payer communications, Appeals and Denial information, and scheduling.

Requirements

High School diploma, general equivalency diploma (GED), and/or GED equivalent programs.
Effective written, oral, and interpersonal communications skills.
Proficient computer, word-processing and Excel spreadsheet skills.
Ability to learn new computer systems, i.e.: EPIC, INDICIA.
Educated in the unique clinical and discharge needs of the patients.
Strong time management and priority-setting skills.
Ability to work independently and as a team member.
Self-directed with the ability to take the initiative to solve problems.
Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.

Nice To Haves

Health Care Experience.

Responsibilities

Utilization Management: Responds to payer requests and inquiries, prepares Appeals and Denial information, manages Livanta appeal process, provides patients with IM Letter from Medicare prior to discharge, reviews daily admission data to verify inpatient insurance coverage, pre-certs, and authorized days, alerts Care Coordinator to potential problems, contacts admitting to obtain necessary authorization/precert information if missing or incorrect, performs daily log reconciliation, utilizes Information System to retrieve necessary information for case management and utilization review, retrieves information for Physician Advisors, works the discharged not final billed (DNFB) report, verifies admission and discharge date information, updates Utilization Review RN for payors, and enters documentation into EPIC/Applicable IT system for denials/lower level of cares.
Insurance Authorizations: Contacts insurance companies for benefit coverage and obtains authorizations when needed, handles SAR, and arranges ambulance transport.
Post - Acute Care Referral Management: Manages referrals to external facilities & services including Assisted Living Facilities, Acute Rehab, Subacute Rehab, LTAC, Hemodialysis, DME, Hospice, Palliative Care, Wound Care, Home Health Services, and Community Resources. Obtains necessary supportive information from the medical record and manages referral documentation.
Appointment Scheduling: Arranges Medicaid appointments and follow-up appointments at MD's offices and/or clinics as requested.
Additional Duties: Faxes medications, EARC or PASSR to State of NJ Offices, and applications for Medication assistance as requested. Adheres to HMH Organizational competencies and standards of behavior.
All other duties as assigned.