Immediate Home Health and Hospice is a leading provider of home health and hospice services in the Philadelphia, PA area. Our mission is to provide exceptional home health and hospice services to patients who need our help the most.
We are seeking talented, passionate individuals to join our team and help our patients live happier and healthier lives…in their homes.
What We Offer*:
We know that, to be the best place for our patients, we must be the best place to work for our employees. We offer the following to our employees:
Position Summary: You will work on a full-time basis to oversee and provide the best continuity of patient care by the Admissions Coordinator will work within Immediate Home Health & Hospice requirements for completion and turn-around times for requests and assists with adherence to established processes.
Responsibilities include but are not limited to:
1. Perform data entry and case review of prior authorization request submitted to the Medical Management department.
2. Gathers clinical documentation for cases preparation. Assists in the medical review process of authorization requests and claims review as appropriate to assist in making medical necessity decisions and benefit determinations.
3. Communicates with members and providers regarding benefit issues and keeps up to date on health plans and
benefits associated with each type of plan.
5. Maintains documentation of decision-making regarding each case.
6. Works closely with other nursing staff to discuss cases and for making determinations.
7. Communicates with clinic and other requesting facility staff and practitioners to obtain additional information for case documentation.
8. Maintains proficiency in use of computer access to obtain medical information needed.
9. Attends daily stand up and stand down meetings.
10. Assists with writing and sending of non-authorization letters.
11. Takes accurate and complete telephone messages and refers calls to RN as necessary.
12. Identifies and refers potential quality of care issues to RN Case Manager for follow-up.
13. Attends and actively participates in Medical Management Meetings.
14. Participates in Medical Management activities and attends departmental in-services as scheduled.
15. Assists with second review of claims.
16. Participates in internal quality reviews to support continuous quality improvement initiatives within the department.
17. Supports Quality Care Coordinators with programs as necessary.
18. Adhere & Uphold Immediate Home Care & Hospice Mission, Vision and Values and Health Service & Performance Standards
19. Other duties as assigned.
Qualifications:
*Eligibility for certain benefits may depend on employment status
Immediate Home Health and Hospice is an equal opportunity employer committed to providing equal employment opportunities without regard to race, color, religion, sex (including pregnancy), sexual orientation, age, national origin, disability, genetic information, veteran status, or any other classification protected by applicable law.
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