Transitional Care Specialist

Position Purpose:

This position will provide agency operations support by initiating and maintaining all aspects of patient episodes of care including, but not limited to, referral processing and compliance efforts, authorizations and denials/investigations, patient and clinical team scheduling, quality auditing, and patient experience projects.  The position will also assist leadership in all preparations for The Joint Commission and other regulatory surveys (i.e. Probe and Educate requests).

This position is responsible for ensuring operational accuracy through daily episode of care analysis, quality reporting, and identification of compliance discrepancies. High level organizational and problem-solving skills are necessary. Specific patient caseloads will be assigned by leadership. This position will require detailed knowledge and use of Epic, Midas, and all insurance request websites (Medicare, Medicaid, Amerigroup, etc.). Interactions with the Central Business Office, IT, Revenue Cycle IT, and external referral sources will be frequent and monitored by leadership.

This position will be assigned additional administrative and operational tasks as needed.

Nature and Scope:

The nature and scope of managing designated caseloads will include:

·         Administrative maintenance of all episodes of care for patient caseload.

·         Reviewing reports in Epic and analyzing results regarding agency quality initiatives.

·         Utilizing several insurance websites in order to request and obtain authorizations/investigate denials. Collaboration with the Central Business Office is needed during such investigations.

·         Processing new referrals and ensuring receipt of documentation specific to Home Health/ Hospice conditions of participation and compliance standards. Reaching out to doctors' offices on a regular basis.

·         Troubleshooting referral issues/concerns and working with leadership to streamline and improve experience for referring agencies/MDs/etc.

·         Maintaining up-to-date knowledge of all related standards and requirements for new patients. Collaborating with Clinical Leadership to ensure all accepted patients are clinically appropriate for Home Health / Hospice Services.

·         Collaborating with clinical staff to ensure all patients are seen in a timely manner and in accordance with physician orders.

·         Participate in quality improvement and change management procedures and processes.

·         Own and regularly review DNBs and Stop Bills to ensure appropriate billing.

·         Maintaining HARs (Hospital Account Records) and closing when appropriate.

·         Maintain regular contact with all patients on caseload. Consistently verify that services are going well, that patient is safe at home, and that all inquiries are addressed timely.

·         Utilize Midas for safety event and compliance reporting.

·         Participate in agency Interdisciplinary Team meetings.

·         Participate, as needed, in Emergency Operations, Forms Committee, Home Health / Hospice QAPI

Overall, under the direction of the Leader/Director, shall work closely with Other appropriate departments.

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This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Additional administrative tasks will be assigned by a manager as needed.

Minimum Qualifications:  Requirements - Required and/or Preferred

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. High school diploma or equivalent. Associate's degree preferred.

Experience:

Two years of quality experience, word processing and spreadsheet. Knowledge and application of Home Health operations preferred. Strong organizational and communicative skills.

License(s):

None

Certification(s):

None

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.