Posted in Other 30+ days ago.
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Type: Full Time
Location: aurora, Colorado
Job Code: 03170-72188
Work From Home
The Medical Center of Aurora is Metro Denver s first community hospital to earn a Magnet Recognition for nursing excellence. This hospital has received multiple awards and or certifications for Primary Stroke, and Chest Pain. TMCA was ranked as a #4 hospital in the Denver Metro area and the #4 hospital in Colorado in US News & World Report s 2014-2015 Best Hospital Rankings. TMCA is a Level II Trauma Center with 346 beds and a Level III NICU. TMCA is also an Emergency Nurse Association Lantern Award Recipient for 2013-2016, State of the art Heart Care Tower, Community Hospital Cancer Program accreditation from America College of Surgeons Commission on Cancer. NAPBC-accredited Breast Cancer Care Center, Rocky Mountain Hospital for Children s affiliation, and an affiliate of HealthOne, Denver s largest healthcare center.
* Position Summary: Under general supervision of the Division CRS manager, The Central Authorization Coordinator is responsible for managing. Coordinating all day-to-day inpatient rehabilitation admissions with the Clinical Rehabil itation Specialists and/or admissions staff with all managed care payers. This includes util izing a holistic interdisciplinary approach to coordinate the insurance approval of care of all rehabilitation patients to assure smooth, efficient functioning rehabilitation units and delivery of quality health care services. Acts as the clinical resource for the department. Utilizes other clinical specialists/coord inators as a resource for clinical growth, operations improvement, and for the coordination/participation in quality improvement activities and audits as necessary, development of new programs and clinical procedures, and collaboration with NTX Division Rehab Units to promote efficiency and customer service and assists Program Directors as necessary to promote effective daily operations. Assist AVP with coordination and management of central authorization program. Supports Continental Division Excellence Always standards and mission/vision of hospitals that are supported. Assumes additional supervisory/administrative responsibilities as assigned by AVP/Program Director.
Majority of the responsibilities involves central insurance authorization for the IP Rehab Service Line for the Continental Division for the effective and efficient admissions process in the delivery of these services. Continuously evaluates, develops a plan and conducts business with insurance payers for the appropriate approval/authorization for inpatient rehabilitation patients to meet the individual needs of medically referred patients in an efficient, productive manner and within the established guidelines for HCA and Nursing Professional Standards for Practice and Code of Ethics. To maintain accurate, current records on all patients according to policy and procedures. To assist with educational programs for departmental and hospital associates and to uphold the standards of the department and hospital by dealing with patients, visitors, associates and other medical professionals in a respectful, courteous manner.
Job Duties and Responsibilities:
* Performs pre-certifications, insurance verifications and is responsible for the data integrity with regard to referral tracking
* Coordinates final admission approvals that come through communications with the Medical Director, Clinical Rehab Specialist and Program Director.
* Gathers and collects pertinent clinical information to aid in the insurance approval process.
* Cultivate positive relationships with and maintain an environment of collaboration and cooperation at all levels of the organization, including the Medical and clinical staff, referral sources and community partners.
* Positively and professionally represents the unit with internal and external customers, other shareholders, and the public.
* Meets position requirements and performs essential functions.
* Provides timely, accurate and complete reports as requested.
* Communicates effectively and appropriately when handling calls.
* Responds within established time frames to request for in-patient insurance approval.
* Accurately assesses patient condition, status, needs and medical record data for cost/benefit analysis and medical determination for program admissions.
* Complete admission assessment forms in complete and legible manner to include all authorization numbers, days approved and when updates are due.
* Accurately applies primary and secondary medical diagnostic information to support presentation of assessment/admission the insurance provider and all other necessary parties.
* Assures payment sources are current, accurate and available.
* Provides pertinent clinical information to non-Medicare payers, for initial pre-certification of rehab stay in a timely manner.
* Communicates/collaborates effectively and timely with CRS, Program Director and/or Medical Director as needed, relaying non-Medicare insurance information, to allow for timely approval and admission.
* Enters all pertinent information in hospital computer system documenting information accurately and completely.
* Ensures information related to the patient's benefits and resources is accurately documented in hospital computer system.
* Demonstrates knowledge to appropriately communicate to CRS and/or Case Manager; the patient's financial responsibility and requirements for insurance benefits.
* Coordinates payment negotiation s as dictated by Business Office Manager, Rehab Program Director and/or Finance Department.
* Knowledge of the objectives of the company and implication for programs, policies, and decisions.
* Knowledge of methods and procedure for the analysis, interpretation, and display of
* Ability to identify and resolve causes of business, staff, and customer problems using quality improvement principles.
* Ability to meet productivity goals for department on a consistent basis.
* Ability to analyze and interpret numerical/statistical information to draw conclusions.
* Ability to identify and implement cost-reduction opportunities.
* Develops and communicates a shared vision for department(s) consistent with the goals and objectives of the Division.
* Develops strategic plan/goals to support departmental progress and achievement of hospital goals.
* Demonstrates ability to make effective and timely decisions.
* Ability to maintain performance in stressful situations.
* Ability to set priorities when faced with conflicting alternatives and varying conditions.
ABILITY TO PLAN AND CONDUCT MULTIPLE ACTIVITIES WITHIN A SPECIFIED PERIOD IN ORDER TO ENSURE
Last Edited: 06/12/2018
Diversity is valued and actively promoted in the workforce at all levels. We strive to celebrate cultural and other differences and consider them strengths of the organization.
We are committed to:
Providing an inclusive work environment where everyone is treated with fairness, dignity and respect.
Recruiting and retaining a diverse staff reflective of the patients and communities we serve.
Equal employment opportunities are provided to all employees and applicants for employment without regard to race, color, religion, gender, national origin, citizenship, age, disability, sexual orientation, genetic information, gender identity, protected veteran status, or any other legally protected category in accordance to applicable federal, state, or local laws.
The policy applies to all terms and conditions of employment including, but not limited to, hiring, placement, promotion, termination, layoff, transfer, leaves or absence, compensation and training.