Under general supervision and according to established policies and procedures, provides assistance to Care Management functions for the site. Participates as a member of the Care Management Team to facilitate process flow in care coordination activities and transition planning. Communicates with Third Party payers and other community resources to assist in the patient disposition process. Interfaces with Patient Financial Services on issues related to eligibility, benefit coverage, and appropriate provider. Performs input into various databases as appropriate for utilization management, LOS management and Denial Management activities. Audits data input and corrects errors, as needed. Investigates and responds to inquiries related to the authorization process, benefit coverage and general concerns regarding policies and procedures. Maintains necessary utilization review files for all patients in the hospital. Validates discharge dispositions and assists with issuing Medicare Important Message letters prior to discharge. Establishes and maintains effective relationships with physicians and all other staff members, internally and externally. Identifies problems or any dissatisfaction experienced by any customer or referring source and works to resolve them to a high degree of service excellence. Uses positive interpersonal skills to effectively resolve conflict. Promotes a positive customer relations environment. Performs related clerical/secretarial duties as needed. [BRASSRING IMPORT 9/1/16]
1. High school diploma or equivalent. 2. One to two years related experience in an outpatient clinic or hospital setting, including six to twelve months of data entry experience. 3. One to two years work experience in an insurance, medical records, billing or related area desirable. 4. Medical Assistant certification, license to practice as a Licensed Practical Nurse (LPN), or college coursework in heath care preferred. 5. Additional training in computer applications preferred. 6. Working knowledge of medical terminology desired . [BRASSRING IMPORT 9/1/16]
PRIMARY LOCATION:Detroit, Michigan
FACILITY:DMC Receiving Hospital
IF OTHER SHIFT, SPECIFY:Weekend Rotation
SHIFT BEGIN:8:00 AMSHIFT END:4:30 PM
Employment practices will not be influenced or affected by an applicant?s or employee?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.
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