Authorizations and Orders Specialist

JOB SUMMARYResponsible for coordinating home care services for managed care patients, which includes establishing and maintaining the patient's plan of care, establishing and maintaining positive relationships with managed care customers and related referral sources.

DUTIES & RESPONSIBILITIESVerifies insurance coverage and obtains initial authorizations for services and seeks reauthorization for ongoing and additional services.Works with Director or Nursing and staff clinicians to gather, collate, and report patient care summary information to managed care Case Managers with other insurances.Maintains comprehensive working knowledge of managed care contractual relationships and ensures that patients are admitted, and services are delivered in accordance with contract provisions.Works with members of the billing team to ensure that managed care customers are billed according to Case Manager Agreements.Establishes and maintains positive working relationships with current and potential managed care customers.Promptly responds to managed care customer's requests and concerns.Assists in building community, customer, and payer and patient perceptions of Excell Home Care & Hospice as a high-quality provider of services.Maintains comprehensive working knowledge in the field of managed care and shares information with appropriate organization personnel.

Performs/oversees:

Order/F2F Tracking-monitors all aspects of Plan of Treatment/order tracking, to include checking in orders/Plan of Treatment on a daily basis, verifying all incoming orders are signed and dated by physician and/or Excell staff as appropriate. Accurately encodes physician orders, Medicare certification/recertification. Performs/oversees open orders report for timely approval. Regenerates late orders for signature (Supplemental 14 days, Certification 21 days). Works with physician liaisons as appropriate. Manages clinical records functions including establishing and implementing clinical records policies. Ensures clinical record systems are maintained in compliance with state, federal and regulations. Protects all clinical records through the establishment and implementation of control procedures for all open and closed records. Protects the confidentiality of patient and organization information through effective controls and direct supervision of clinical records. Forwards copies of clinical records to authorized users according to policy. Monitors aged unsigned physician orders and submits second and third requests for signed orders to overdue physicians, calls or visit the offices of seriously overdue physicians. Supervises the use of the clinical records information system and mains a comprehensive working knowledge of the system including upgrades and enhancements.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description.

The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at http://www.pennantgroup.com.#J-18808-Ljbffr