Hospice Specialist - Intake

Northeast Georgia Health System•Gainesville, GA

11d

About The Position

The Hospice Specialist processes hospice referrals and schedules admission visits in accordance with Hospice of NGMC policies and procedures. The role serves as a resource to physicians, administration, payer sources, supervisors, and staff on referrals, admission requirements, payors, and community services. It gathers complete and accurate information and completes requirements that support reimbursement, coordinates referral follow-up and admission arrangements, obtains appropriate orders, verifies benefits, supports patient consultations or admissions, ensures accurate admission documentation, and closes out non-admissions. The specialist also provides customer service through the Access Center telephone, triages calls, uses hospice and hospital software systems, and trains and directs the Hospice Secretary II position. The role facilitates intake and case management to promote efficient continuity of care, processes and pre-qualifies referrals, and coordinates with referral sources, patients, families, clinicians, and other staff. It verifies clinical, demographic, financial, and insurance information; supports hospice admission decisions in consultation with physicians; coordinates scheduling; maintains referral and admission records and databases; tracks referral outcomes; and supports reimbursement, billing, and authorization requirements. The specialist also helps educate referral sources and staff, maintains physician licensing information, coordinates weekly Fast Rounds, and supports accurate and effective organizational operations. This position 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. Knowledge of state and federal care and reimbursement regulations, strong customer-service and communication skills, critical-thinking and organizational abilities, collaboration skills, and computer skills are relevant to the role. The work includes reading, writing, reasoning, talking, keyboarding, and driving. Physical demands include frequently lifting and carrying up to 30 pounds, constant moderate vision demands, and occasional kneeling, stooping, bending, standing, walking, and pushing or pulling.

Requirements

State of Georgia Registered Nurse (RN) or Licensed Practical Nurse (LPN) license.
High school diploma or GED.
Two years of healthcare experience for an RN, or five years of healthcare experience for an LPN.
Knowledge of state and federal regulations regarding care and reimbursement.
Excellent customer-service and verbal and written communication skills.
Excellent critical-thinking and organizational skills.
Ability to collaborate with patients, families, admission staff, physicians, and providers while handling multiple tasks.
Computer skills, including Microsoft Windows, Word, Excel, and database use, are relevant to the position.
Ability to perform job activities involving reading, writing, reasoning, talking, keyboarding, and driving.
Ability to frequently lift and carry up to 30 pounds.

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

Process hospice referrals and schedule admission visits according to organizational policies and procedures.
Obtain and verify medical, demographic, insurance, and financial information; secure appropriate orders and support benefit verification and certification requirements.
Coordinate referral follow-up, patient consultations, admission arrangements, and scheduling with admission nurses and other staff.
Communicate with referral sources, patients and families, physicians, payors, and internal teams to support continuity of care and admission processes.
Consult with the attending physician or Hospice Medical Director regarding hospice admission appropriateness and applicable requirements.
Notify patients and verify information, obtain directions to patient homes, and identify interpreter needs.
Inform staff about new and pending admissions and educate staff and referral sources about hospice admission, coverage, medical, and financial requirements.
Refer patients to other organizations or community resources when hospice admission criteria are not met, and explore available options to meet patient needs.
Enter referrals and intake information into clinical and office systems; assign referral numbers; maintain accurate referral and admission records and databases.
Track referral dispositions and non-admissions, conduct follow-up calls, and use referral statistics to analyze outcomes.
Apply ICD-10 coding to diagnoses before processing referrals.
Verify payer guidelines, benefits, precertification requirements, Medicaid documentation, admission financial documents, billing documentation, and insurance case-management follow-up.
Maintain records of insurance case-management follow-up and provide updates needed to continue service authorizations.
Maintain a database of licensed ordering physicians, verify current licensure, retain proof of licensure, and check for Medicare/Medicaid exclusions.
Process referral and admission paperwork and charts, forward records to medical records, and quality-check documents for accuracy and completeness.
Assist admission nurses with coordination and staff assignment, including use of Zeemaps.
Coordinate admission demographics and billing information with billing staff; work assigned queues to correct intake errors and communicate billing discrepancies.
Register admission and billing information accurately in EPIC and maintain admission, referral, and billing logs.
Coordinate weekly Fast Rounds, maintain the review log and book, and track patients requiring follow-up within the 30-day order window.
Train and direct the Hospice Secretary II or Intake Secretary and support effective organizational operations.
Provide customer service on the Access Center telephone, triage calls, and use hospice and hospital software systems.
Apprise the Access Center Supervisor of service-improvement needs raised by other entities.