Hospice Specialist - Intake

Northeast Georgia Medical Center•Gainesville, GA

About The Position

Responsible for processing hospice referrals and scheduling admission visits in accordance with Hospice of NGMC policies and procedures. The position serves as a resource to physicians, administration, payer sources, supervisors, and staff regarding referrals, admission requirements, payors, and community services. It gathers complete and accurate information and completes requirements to support reimbursement. The Hospice Specialist coordinates initial patient referrals and follow-up, obtains appropriate orders, verifies benefits, assists with patient consultations and admissions, ensures accurate admission documentation, and closes out non-admissions. The role provides customer service through the Access Center telephone, triages calls, and uses hospice and hospital software to collect required information. It also trains and directs the Hospice Secretary II position. The role requires a Georgia RN or LPN license and a high school diploma or GED. Minimum healthcare experience is two years for an RN or five years for an LPN. A bachelor's degree and experience in hospice, oncology, or home health are preferred.

Requirements

State of Georgia Registered Nurse (RN) or Licensed Practical Nurse (LPN) license.
High school diploma or GED.
At least two years of healthcare experience for an RN, or five years of healthcare experience for an LPN.
Knowledge of state and federal regulations related to care and reimbursement.
Excellent verbal and written customer service and communication skills.
Strong critical-thinking and organizational skills.
Ability to collaborate with patients and families, admission staff, physicians, and providers while handling multiple tasks.
Ability to use computer systems and software, including clinical and office programs.
Ability to read, write, reason, talk, keyboard, and drive.
Physical ability to lift and carry up to 30 pounds frequently; kneel, stoop, or bend occasionally; stand or walk occasionally; and push or pull occasionally.

Nice To Haves

Bachelor's degree.
Experience in hospice, oncology, or home health.
Hospice-specific knowledge of state and federal care and reimbursement regulations.
Knowledge of Microsoft Windows, Word, Excel, and databases.

Responsibilities

Facilitate the hospice intake and case management process to support efficient continuity of care.
Process and pre-qualify referrals; obtain complete medical and demographic information and communicate effectively with referral sources and care team members.
Coordinate referral and admission scheduling with Admission Nurses, Business Development Specialists, Social Services staff, and other relevant personnel.
Contact patients to verify information, obtain directions, and identify interpreter needs.
Consult with the attending physician or Hospice Medical Director about referral appropriateness under applicable program requirements and organizational criteria.
Ensure timely and accurate processing of referrals, orders, certifications, intake information, and admission documentation.
Inform and update staff about new and pending admissions and coordinate smooth transitions to hospice services.
Explore options for patients who are not eligible for hospice or for whom services are not ordered, including referral to other organizations or community resources.
Educate referral sources and staff about hospice services, admission and coverage requirements, medical and financial requirements, and payment resources.
Conduct follow-up calls on referrals that were not admitted and track and trend non-admissions.
Enter referrals into the information system, assign appropriate numbers, maintain accurate referral and admission records, and analyze referral dispositions using statistical data.
Code diagnoses using the ICD-10 process before referral processing and maintain the referral source database.
Verify benefits and precertification requirements for commercial insurance clients, initiate medical necessity certification when appropriate, and review Medicaid DMA-579 forms for completeness.
Review financial admission documents and assist with billing functions, documentation, follow-ups, insurance case management logs, and authorization updates.
Maintain and update the database of licensed ordering physicians, verify licensure, retain proof of licensure, and check providers against Medicare and Medicaid exclusion lists.
Process referral and admission paperwork and charts, forward records to medical records, and quality-check documents for accuracy and completeness.
Assist Admission Nurses with referral and admission coordination and correct team staff assignment through zeemaps.
Coordinate admission demographics and billing information with the Billing Supervisor, correct intake errors in assigned work queues, maintain logs, and communicate billing discrepancies to the Billing Coordinator.
Register admission and billing information accurately in EPIC.
Coordinate weekly Fast Rounds, maintain the related running log and book, review referrals, admissions, and non-admissions with assigned staff and the Access Center Supervisor, and track patients requiring follow-up within the 30-day order window.
Train and direct the Intake Secretary/Hospice Secretary II and assist with maintaining admission, referral, and billing logs.
Support productive organizational operations and help improve communication and problem-solving among referral sources, payors, and Hospice of NGMC.
Notify the Access Center Supervisor of entities that identify a need for service improvement.