Clinical Intake Coordinator

AMERICAN OUTCOMES MANAGEMENT dba AOM INFUSION•Arlington, TX

28d

About The Position

Responsible for clinical review of services for patients. Has excellent interpersonal skills and can successfully communicate with the referral sources, sales staff, insurance carriers and clinical staff to ensure that the patient’s insurance covers treatment by initiating and securing authorizations, pre-certifications, and/or predeterminations.

Requirements

Graduate of an accredited nursing program.
Active LVN or RN license currently registered in state working in and in good standing with the Board of Nursing.
Experience in healthcare admissions, case management, or referral coordination.
Strong knowledge of insurance verification and prior authorization processes.
Proficiency in CRM systems and referral portals.
Knowledge of ACHC and URAC standards and accreditation process.
Knowledge of regulatory requirements for home care. Good communication skills, detail oriented and organized.

Responsibilities

Review medical documents/information pertaining to the patient’s diagnosis, health history, and medication ordered as required by the patient’s insurance carrier to determine the “medical necessity” of the prescribed therapy.
Effectively communicates with sales, clinical team, patients and family.
Acts as primary liaison between branch personnel and referral sources during patient intake process.
Responsible for communicating sales related concerns and referral source or patient complaints to management.
Ensure timely authorization process for services from the patient’s insurance carrier and the timely communication of insurance information to management, clinical and sales teams.
Review physician’s letter of medical necessity and other medical information as required by the patient’s insurance carrier to determine the “medical necessity” of the prescribed therapy.
Participate in daily patient care rounds to discuss pending referrals, current patients and clinical issues.
Obtain necessary physician’s letter of medical necessity as required by the patient’s insurance carrier.
CareTend and AlayaCare data entry.
Participate in the company’s Quality Assurance Program.
Audit patient medical records for assigned group of patients to assure complete and accurate documentation.
Electronic storage of all patient information including e-mails in Electronic Document Management system.
Assist in any other project given by Director of Intake & Senior Management.