Referral Center RN, VNA of Cape Cod

Cape Cod Healthcare•Hyannis, MA

4h•Onsite

About The Position

The Referral Center RN at VNA of Cape Cod is responsible for identifying, analyzing, and streamlining referral and data entry processes, including insurance verifications and authorizations for both Hospice and Home Health services. This role involves direct operational and supervisory oversight of hospital liaisons, serving as the primary operational point of escalation for hospital partners regarding referral issues, admission barriers, coverage concerns, and service availability. The RN will collaborate with hospital case management, liaisons, and physicians to strengthen referral relationships and improve census. Key duties include managing insurance benefits, problem-solving complex authorization and payer challenges, and developing and maintaining standardized work processes. The position also entails establishing departmental performance metrics, conducting interviews, hiring, onboarding, coaching, training, and evaluating staff, as well as managing PTO and schedules. The Referral Center RN educates staff on regulatory and workflow changes, conducts meetings, and serves as a subject matter expert in e-discharge systems, insurance portals, and EMR. They act as a primary resource for referral sources and insurance providers and provide onsite operational coverage during staffing shortages, including handling phones, faxes, electronic systems, referral entry, and obtaining insurance verification or authorization. The role also involves effective communication with internal departments, maintaining EMR alerts, challenging current practices, identifying process improvement opportunities, and actively participating in the organization’s culture of continuous improvement.

Requirements

In-depth knowledge of disease management, financial and insurance reimbursement
Understanding of Home Health and Hospice regulatory requirements
Familiarity with electronic discharge management systems and EMR

Nice To Haves

Bachelor’s Degree in a clinical field
Two years’ healthcare management experience
Two years’ experience in homecare operations

Responsibilities

Identify, analyze and streamline referral/data entry processes, insurance verifications, authorizations for both Hospice and Home Health.
Provide direct operational and supervisory oversight of hospital liaisons supporting home health and hospice referral sources.
Serve as the primary operational point of escalation for hospital partners regarding referral issues, admission barriers, coverage concerns, and service availability.
Collaborate with hospital case management, liaisons, and physicians to strengthen referral relationships, to improve referrals and home health and hospice census.
Manage insurance benefits in the best interest of the agency and patients including resolving authorization and coverage issues.
Problem-solve complex authorization, payer and referral challenges to minimize delays in care.
Develop, implement and maintain standardized work processes within assigned departments to ensure efficiency, accuracy and consistency.
Establishment of departmental performance metrics and tracking systems’ monitor outcomes and identify opportunities for improvement for all assigned departments.
Conducts interviews and, hires and oversees on-boarding and orientation of new staff.
Conduct ongoing coaching, training and annual timely employee performance evaluations for assigned staff.
Manage PTO requests and staff schedules to ensure adequate coverage and operational continuity.
Educates staff on regulatory changes, workflow changes and organizational policies and procedures for Hospice and Home Health.
Conducts monthly staff meetings and weekly team huddles with assigned departments to support communication, accountability and performance.
Serves as a subject matter expert with e-discharge systems, insurance portals, electronic medical record (EMR) systems.
Act as primary resource and point of contact for referral sources and insurance providers for both Hospice and Home Health.
Provide onsite operational coverage as needed during staffing shortages including phones, faxes, electronic systems, referral entry and obtaining verification or authorization of insurance benefit.
Communicate effectively with internal departments and Team Managers regarding referrals, availability of services, insurance benefit and authorization, scheduling and data entry issues.
Maintain Alerts Reports in EMR to manage “NTUC” volume.
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management.
Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
Other duties as assigned