Description
Responsible for the intake of new and complex referrals to home health and hospice and coordinating services for referred patients
Core Competencies
- Accepts referrals from hospitals, physician offices, SNFs and other community referral sources, obtains required orders for services and coordinates infusion products and DME/HME delivery
- Pre-screens clients referred by physicians for hospice needs, eligibility, and homebound status, if appropriate
- Evaluates patients referred to the Organization; identifies insurance coverage, negotiates payment or per diem rates; plans and coordinates referrals for hospice services.
- Collaborates with the case manager to expedite discharges and screen admission requests..
- Triages the needs of referred patients to assist scheduling for same day or within 48 hours of referral
- Elevates issues as appropriate to the Director, Revenue Cycle.
- Responds to voicemail and emails within 24 hours of receipt. Forwards patient complaints to the Lead Patient Account Representative or Director, Revenue Cycle, when appropriate.
- Stays informed of updated insurance requirements and reimbursement practices
- Maintains an advanced knowledge of insurance payor contracting as well as authorization requirements by payor.
- Maintains knowledge of the methods of payment, pricing and insurance billing.
- Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted and services are delivered in accordance with contract provisions.
- Develops and maintains cooperative relationships with hospital personnel, physicians, suppliers and insurance case managers.
- Arranges for alternate hospice providers utilizing Letter of Agreement for capitated patients out of the service area.
- Sets realistic expectations with patients/families regarding hospice service
Education
DegreeProgramCollege DiplomaNursing
Experience
Number of Years ExperienceType of Experience3Healthcare managed care, home health agency or case management
Compensation Range
$48.77 - $81.51 / Hour