The individual in this position works under direction of RN Case Manager and/or Social Worker. The individualï¿½s responsibilities include but are not limited to the following actions : a) Follow up on patient accounts when authorization for stay is required , Fax numbers to Send clinical reviews b) Follow up on each account during the stay and on discharge for authorization - document in the electronic system, c) Escalate any potential disputes or denial of accounts to Director of Case Management or designee d) Trends disputed claims by at least payor and physician e) assist in obtaining authorization for patient discharged to Skilled Facilities or other post-acute care that require authorization f) other duties as assigned Utilization Management
ï¿½Validates patientï¿½s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed
ï¿½Validates that all commercial/managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) or designee of variances
ï¿½Cases that require authorization are obtained daily by fax or phone and documentation is completed daily
ï¿½Escalate discharged cases at end of day that have no authorization or notification of dispute is provided by payor
ï¿½Concurrently make sure all clinical needed by payors and updates are provided by alerting Case Manager assigned to case and escalating to DCM if not completed timely
ï¿½Trend dispute/denial potential to DCM or designee by failure points in revenue cycle
ï¿½Prepare denial information for UR Committee, Denial and Revenue Cycle Meetings
ï¿½Collaborate with Patient Access, Case Management, Managed Care and Business office to improve concurrent review process
High School diploma or equivalent required. Associate or Bachelorï¿½s degree preferred. Paramedic, EMT or Nursing Assistant certification preferred. Acute hospital experience preferred. Skills required include excellent organizational skills, excellent verbal and written communication skills, demonstrated problem solving skills, and computer literacy. Data Analytic skills preferred
Two (2) years of experience in a clerical or healthcare field.
Primary Location: Worcester, Massachusetts
Facility: Saint Vincent Hospital
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2005036138
About Saint Vincent Hospital
Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.