BASIC FUNCTION: We are searching for the right candidate with prior home health experience to answer all incoming telephone calls while assisting all callers, as well as taking all new patient referrals and answering questions about home health services To verify insurance coverage on all new-patient referrals, prioritizes, organizes and manages insurance verification of Adult, Home Support Services Program and Pediatric patients including coordination of patient care, customer service, and problem negotiation/resolution.
On-Call Rotation (approximately every 6-8 weeks)
- Provides prompt and professional customer service at all times with vendors, staff, clients, patients, and family members of clients while maintaining a positive attitude.
- Responsible for timely answering all incoming phone calls, appropriately directing all calls, and taking messages as necessary.
- Assist all callers with information on home health services, coverage areas, and services provided by agency as requested.
- Obtains new patient referral information from callers, responsible for accurate and timely data entry of patient referrals; prioritize referrals in order of urgency and Start of Care date.
- Immediately notifies the appropriate personnel responsible for scheduling patient care of MD orders and start of care date for patient.
- Maintains effective professional communication with physicians, staff, patients, clients, and family members to coordinate care and problem resolution
- Serves as a resource for branch office coordinators; notifies branches about specific details about new patient referrals, services provided to patients, and coverage areas for care.
- Accurately tracks and logs hospitalized patients in coordination with LVN Intake Coordinators; sends patient information sheet to appropriate staff in hospital/nursing homes in timely manner in coordination with Triage nurse. Communicates that information has been sent to hospital/nursing home to appropriate branches and/or other programs providing patient care.
- May be scheduled to work Triage shifts (nights, weekends and/or holidays on an as needed basis.
- Assist with training for Customer Service Dept new hires.
- Responsible for verifying Medicare, Pediatric and Home Support Services eligibility and all other additional insurance payer sources on all new patient referrals. Ensures patient is not on service with another home healthcare agency.
- Accurately and timely assigns account numbers to all new patients, and completes a Contract Service Agreement for each new patient.
- Responsible for accurate and timely processing of patient referrals; prioritize referrals in order of urgency and Start of Care date.
- Provides timely notification to the appropriate office location and personnel responsible for scheduling care of new patient; fax and email Start of Care information and all other appropriate documentation on patient to correct office location.
- Contacts Insurance Carriers and third party payers to obtain initial pre-authorization for the Assessment/Evaluation visit.
- Communicates detailed benefit insurance information and initial Assessment authorization with timely completion and submission of all required documentation to the appropriate office location, personnel responsible for scheduling care of new patient, billing department, and patient/family.
- Follow up with Insurance Company as needed regarding benefit information or initial pre-authorization.
- Re-verifies Medicare and Medicaid monthly and notifies the branch and billing department regarding all changes in eligibility; additional payer sources, or termed medical coverage.
- Completes all needed follow up regarding Medicare, Medicaid, and other Insurance Payer eligibility.
- Re-verifies coverage on an annual basis for all insurance carriers based on the plans benefit year
- Maintains a list pending patients and follows up as needed.
- Maintains compliance with all At Home Healthcare policies, procedures, and regulations, including all federal and state laws.
- Understands and adheres to continuous quality improvement objectives; participates in quality assurance and improvement activities as requested.
- Maintains a clean and safe work environment.
- Provides clerical and other administrative assistance.
- Attends meetings and training sessions as required.
- Accurately prepares and proofread letters, memos, and other correspondence.
- Daily review and processing of mail and other correspondence.
- Completes accurate and timely documentation.
- Performs all other duties as requested by supervisor.
- Requires ability to speak clearly and make self-understood effectively in face-to-face interactions; articulate with accuracy to communicate using phone, email, communication notes and assigned forms. Excellent customer service and telephone etiquette skills required.
- Requires ability to communicate clearly and make self-understood effectively in face to face interactions; articulate with accuracy to effectively communicate using phone.
- Excellent computer software skills necessary to produce accurate documents and materials required. Working knowledge of MS Office, Excel, or similar software required. Proficient use of MS Office and Excel preferred.
- Home Health experience required.
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