Care Coordination Specialist

Overview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. 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. Responsibilities A day in the life of a Care Coordination Specialist at Hackensack Meridian Health includes: Essential Generic Job Functions: Utilization Management a. Payer communications ` responds to requests and inquiries and provides information as requested. b. Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process. c. Providing patients with the IM Letter from Medicare prior to discharge. d. In collaboration with the Care Coordinator (CC), reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed. Alerts the CC to potential problems with any of the above. e. If the authorization/precert information is missing or incorrect, the Specialist will contact admitting to obtain the necessary and accurate information. f. Daily log reconciliation. g. Utilizes Information System to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process. h. Retrieves information for the Physician Advisors as needed. i. Works the discharged not final billed (DNFB) report to determine outlier days, approved days, etc., and releases accounts as appropriate. j. Verifies admission and discharge date information. k. Updates Utilization Review RN needed for payors. l. Enters all documentation into EPIC/Applicable IT system for denials/ lower level of cares. Insurance Authorizations a. Contacts insurance companies for benefit coverage and obtains authorizations when needed. b. SAR c. Ambulance Transport. Post - Acute Care Referral Management Manages Referrals to external facilities & services including but not limited to the following: Assisted Living Facilities Acute Rehab 3. Subacute Rehab New referrals & Returns LTAC 5. Hemodialysis New & Returns DME Hospice Palliative Care Wound Care Home Health Services Community Resources b. Obtains necessary supportive information from the medical record. c. Manages Referral Documentation. Appointment Scheduling a. As requested, arranges Medicaid appointments. b. As requested will arrange follow up appointments at MD`s office and/ or clinics. 5. Additional Duties a. As requested faxes medications, once received from CC to a particular pharmacy. b. As requested faxes EARC or PASSR to State of NJ Offices. c. As requested faxes applications for Medication assistance. d. All other duties as assigned. 6. Adheres to HMH Organizational competencies and standards of behavior. Qualifications Education, Knowledge, Skills and Abilities Required: 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. Education, Knowledge, Skills and Abilities Preferred: Health Care Experience. Starting Minimum Rate Minimum rate of $21.73 Hourly Job Posting Disclosure HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to: Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness. Experience: Years of relevant work experience. Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training. Skills: Demonstrated proficiency in relevant skills and competencies. Geographic Location: Cost of living and market rates for the specific location. Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization. Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered. Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts. In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits. #J-18808-Ljbffr Hackensack Meridian Health