Billing Manager

Billing Service ManagersJobs for Humanity is collaborating with Upwardly Global and with Billings Clinic to build an inclusive and just employment ecosystem. We support individuals coming from all walks of life. Company Name: Billings ClinicJob DescriptionUnder the direction of department leadership, social service care manager staff provide services consisting of comprehensive case management, care coordination, continuing care services, and clinical social work services including crisis intervention and emotional support within the professional's defined scope of practice. In addition, the social services care manager is responsible for providing education addressing physical, psychosocial, financial, environmental, and other needs of patients and families and/or significant others. The social services care manager is part of an interdisciplinary team who promotes health and address medical and non-medical barriers.Essential Job Functions:Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations.Meets all mandatory organizational and departmental requirements.Maintains competency in all organizational, departmental, and outside agency requirements.Coordinates patient needs between support systems, healthcare professionals, community, and state agencies.Serves as a liaison between hospital, clinic, and community agencies to facilitate care coordination and the exchange of clinical and referral information.Advocates for and assists the patient as they move across the care continuum.Treats all patients with compassion and respects individual rights to self-determination.The responsibilities of the SW care manager are listed below, in order of priority and intended to ensure effective prioritization of tasks:Priority 1: Reviews New Patients for Psychosocial NeedsReviews Cerner census and ensures all patients are accounted for on assigned floorMeets with unit assigned Care Manager at the beginning of every shift to determine which patients have complex psychosocial needs requiring social work assessment and discharge planning interventionsCollaborates with Care Manager to evaluate patients with psychosocial needs, including but not limited to, patients with the following needs:Psychosocial AssessmentCrisis intervention/TraumaAdjustment to illness/new diagnosisGrief & bereavement, end-of-life concernsChronic substance abuse (assessment and referral)Abuse and/or neglect (consultation)Sexual assaultAdvance DirectivesSelf-payCompetency concernsHomeless/Unsafe dischargeGuardianship/AdoptionMental health/behavioral issuesPatients admitted from Skilled Nursing Facilities or Alternative Living FacilitiesThe Women's Center - mother and/or baby issuesIdentifies patients and families needing support for emotional, social, and financial consequences of illness and/or disabilitiesAccesses and mobilizes family and/or community resources to meet identified needsCollaborates with the Palliative Care Team related to treatment, end-of-life decisions, and bereavementEducates and communicates with multi-disciplinary team on any social, emotional, cultural, environmental, economic, and/or supportive care needs for targeted patientsPriority 2: Initiates and Coordinates Discharge Planning for Assigned PatientsCollaborates with Care Managers for resolution of complex patient problems and coordinates community resources as needed, to achieve desired treatment outcomesParticipates in discharge planning activities for complex patients, to ensure a timely discharge and to provide appropriate linkage with care providers, post-dischargeIntervenes with families exhibiting complex family dynamics which impact directly on patient care and plan for dischargeCommunicates with Care Managers regarding the discharge planning status of all patients referred to Social WorkNotifies Care Management Department of newly identified resources or change in previously identified resourcesUtilizes proactive discharge planning to engage the patient/family/caregiver in the development and implementation of the discharge planDiscusses patient's discharge plan and needs with the care teamDocuments discharge plan, patient's and/or patient's representative understanding of the plan, and their input to the plan, including refusal of discharge planEducates patient or patient representative regarding post-acute options, obtains a minimum of 3 choices for post-acute services, and documents choices per policyEnsures authorization is obtained for post-discharge services, if required; follows-up with facility and/or payer daily, if authorization is not obtained within 24 hoursContacts referral agencies to make post discharge arrangements for patients, including verification of bed availabilityConfirms actual and projected discharge dates with patient, family, and/or patient representatives; ensures transportation is arrangedUpdates post-acute providers of patient's discharge condition and final discharge plansReassesses and documents discharge needs throughout the patient stay at minimum every 3 days, or as patient condition changes; communicates changes with patient and/or patient representativePriority 3: Attends MDRs, Department Meetings, and Additional TrainingsAttends MDRs on assigned unitsIdentifies anticipated discharge date for assigned patientsAttends 1400 afternoon huddles with charge nurse and nurse care manager to ensure action items from MDRs have been completed; escalates barriers to supervisorPresents and discusses transition plans of assigned patients at MDRsProvides Care Management Department Supervisor and/or Managers timely follow-up of action items discussed at MDRs before end of shiftAttends departmental meetings and/or trainings as scheduledPriority 4: Leads Patient-Family ConferencesAssesses needs for discussion with patient, family, physician and care team regarding patient's care or discharge planSchedules and leads patient care conferences to resolve issues and provide clarification to patient, physician, and familyPriority 5: Escalates Barriers as AppropriateDiscusses barriers to discharge with attending physician and/or multi-disciplinary team; if unsuccessful or unable to resolve issues, escalates to Supervisor, Manager, or DirectorInsurance and Utilization ManagementMaintains working knowledge of CMS requirements and readmission penaltiesMaintains working knowledge of insurance/payer benefitDocuments accurately and in a timely manner in the Electronic Medical Record per program guidelinesUtilizes standards of professional practice in all documentation and communication consistent with organization/department policy as well as the Board of Nursing and ethical guidelines established and universally supported by the nursing professionAssures documentation and patient information is secure and maintained in accordance with Billings Clinic policy, HIPPA, state and federal guidelinesParticipates in continuing education, department planning, work teams and process improvement activitiesMaintains current LicensureAdheres to department and organizational policies addressing confidentiality, infection control, patient rights, medical ethics, advance directives, disaster protocols and safetyDemonstrates the ability to be flexible, open minded and adaptable to changeMaintains competency in organizational and departmental policies/processes relevant to job performanceUtilizes standards of professional practice in all communication with patients, support systems and colleagues consistent with the Board of Nursing and ethical guidelines established and universally supported by the nursing professionPerforms all other duties as assigned or as needed to meet the needs of the department/organization