Discharge Assistant - Care Management

How You’ll Help Transform Healthcare:

Schedules peer-to-peer (P2P) conversations between Carilion providers and payor liaisons, gathers required clinical and demographic data for UM/Appeals cases and dissemimates to appropriate recipients, supplies payor information to UM team and documents actions taken.
 

• Prioritizes work to maintain workflow functions as needed. Fields faxes, voicemails, written correspondences, categorizes and disseminates mail.
• Arranges and documents P2P requests, post P2P determinations, denial, and approval information from payors; provides missing or updated demographical/clinical information needed for authorization determinations; on front line of appeals process, communicates with payors, Carilion billing department and UM team for appeals case submissions; explores inquiries regarding benefits, coverage, and insurance questions. Assists Central Resource Center (CRC) staff with certain workflows, e.g., regulatory letters and Virginia MLTSS (UAI) approval process as needed.
• Maintains databases and spreadsheet files, ensuring accuracy, production, and distribution; manages Epic work queues with appeals, denials and P2Ps and tracks related data.
• Researches and resolves issues and concerns ensuring a timely turnaround to facilitate throughput.
• Supports regulatory tasks that are federally mandated, such as the Medicare Important Message (IM), Lifetime Reserve (LTR) Day and Status Change letters.
• Aids in completion of demographic information to facilitate delivery of in person letters to patients (IM, observation to IP, LTR, and Code 44, etc.).
• Collaborates with UM team and Carilion billing to verify and add LTR day information to letters for delivery.
• Receives Notice of Medicare Non-Coverage (NOMNC) letters for patients that are in swing beds and disseminates to all Care Management team members in a timely manner.
• Documents delivery in patient’s electronic medical record and notifies billing department as appropriate.
• Provides letter delivery at regional facilities as needed.
• Processes health plan specific referral requirements including prior authorizations and assists with denial/appeal resolutions, as well as P2P initiations related to admission and throughput needs.
• Resource/liaison to payors, billing, staff, patients and providers. Answers phone calls re: pricing, benefits, coverage, approvals, denials, and insurance questions.
• Facilitates timely collection of paperwork, signatures, and other correspondence from the UM Care Management team and external agencies required to facilitate a timely discharge.
• Assists UM medical and nursing staff as needed.
• Travels between regional facilities to support and facilitate timely patient progression/ throughput needs.

What We Require:

Education: Associate degree or equivalent combination of education or equivalent 2 years of experience.

Experience: Two years experience in data collection and analysis and/or advanced secretarial support required. Experience in emergency services or healthcare practice setting preferred.

Licensure, certification, and/or registration:

Virginia MLTSS (UAI) Certification required to complete orientation and must be maintained throughout employement.

Other Minimum Qualifications: Advanced computer skills with knowledge of a variety of software programs, including Microsoft word, Excel, Access, word processing, spreadsheets and presentation or database software. Excellent communications and organizational skills required.

About Carilion

This is Carilion Clinic ...

An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.

Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.