Job Objective:
Under the direction of the Director of Case Management, or designee, the Case Management Assistant supports the functions of the Patient Care Coordination department by performing a wide variety of administrative duties.
Essential Duties and Responsibilities:
A. Case Management Assistance
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Facilitates communication to department team members from internal and external sources by coordinating telephone calls and messages
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Utilizes and documents in the computer systems to facilitate case management workflow and communication
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Monitors computer system for admission and continued stay insurance authorizations notifying the Case Manager when a clinical update is needed
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Submits clinical reviews to appropriate review agencies and documents in the computer system
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Follows up with review agency for authorized days and documents in the computer system
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Coordinates the retroactive utilization process by tracking accounts needing reviews, ordering medical records, submitting completed reviews and documenting authorizations or denials
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Coordinates the insurance authorization process with appropriate hospital departments.
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Assists with referrals to other facilities, home health agencies, and DME agencies
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Arranges ambulance, as well as other forms of medical and taxi transportation
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Provides support to the discharge coordination process
B. Clerical Duties
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Answers telephone calls and greets customers in the department with the highest level of customer service
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Provides taxi vouchers
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Coordinates mailing of department documentation
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Assists the department director with payroll reporting and processing
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Establishes and maintains an accurate detailed record for the department billing and payment of vendor claims
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Prepares and records department check requests and purchase orders
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Efficiently and cost effectively orders and organizes office supplies
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Prepares letter, memos, and other documents
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Assists with scheduling of meetings and provides clerical support as needed
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Sorts and distributes office mail
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Maintains department patient information files
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Maintains department records for regulatory compliance purposes as indicated.
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Other duties as assigned within skill sets and abilities.
Non-Essential Duties:
Assist with other duties as assigned, within skill sets and abilities
Knowledge, Skills and Abilities:
Knowledge
Familiar with Government, State, HMO, PPO, Commercial, and Workers Compensation authorization and billing guidelines
Working knowledge of Microsoft Office applications
Knowledge of medical terminology
Skills
Knowledge of basic personal computers
Proficient in the operation of scanners, copiers, fax machines Good oral and written communication skills Good interpersonal skills and customer focus
Abilities
Ability to handle stress
Ability to manage a heavy caseload in an organized and efficient manner
Ability to maintain a working relationship with other departments within the organization
Ability to document account information at time of account follow-up
Ability to run case management related reports as needed
Core Competencies: All AVH employees will effectively demonstrate these behaviors:
Accountability
Action Oriented
Customer Focused
Compassion
Effective Communication
Teamwork
Ethics & Values
Integrity & Trust
Education and Experience: Education
Experience
Minimum 2-years healthcare related office experience, preferably in an acute care setting
Required Licensure and/or Certifications:
AVH Conduct/Compliance Expectations:
Ability to adhere with AVH Leaves of Absence Policy
Ability to adhere with AVH Paid Time Off (PTO) Policy
Ability to adhere with AVH Recording of Hours Worked Policy
Ability to adhere to the department dress code
Ability to organize work and establish priorities
Ability to expand on own initiative in performance of duties
Skill and ability to follow the telephone etiquette/standards
Conforms to AVH Standards of Excellence
Ability to function effectively under pressure and meet time parameters
Ability to communicate effectively while maintaining good working relationships with coworkers, managers and other hospital staff
Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVH
Ability to maintain the confidentiality of patient, hospital and department information
Ability to adhere to safety rules and regulations
Safely and effectively uses all equipment necessary to carry out duties
Ability to interpret and function under hospital and department policies and procedures
Conforms with required and appropriate Joint Commission requirements
Conforms with and supports hospital quality assurance and improvement guidelines
Ability to participate effectively in department and hospital staff education
Display a willingness to work as a team player
Ability to give and support the highest level of patient/customer satisfaction at all times
Supports and adheres to the values and mission statement established by the AVH Board of Directors
Ability to demonstrate knowledge and understanding of Corporate Compliance rules and regulations, complies with duty to report behavior standard, demonstrates understanding of purpose for Corporate Compliance hotline and importance of seeking guidance from a supervisor when in doubt regarding a possible corporate compliance issue
Key Physical Requirements and Working Conditions:
Primarily works in a climate-controlled area
Sitting 80% of time on duty
Tolerate repetitive arm and hand movements
A detailed description of the physical requirements of this job is maintained in the Employee Health Department.
Education: