The nature and scope of managing designated caseloads will include:
• Administrative maintenance of all episodes of care for patient caseload.
• Reviewing reports in Epic and analyzing results regarding agency quality initiatives.
• Utilizing several insurance websites in order to request and obtain authorizations/investigate denials. Collaboration with the Central Business Office is needed during such investigations.
• Processing new referrals and ensuring receipt of documentation specific to Home Health/ Hospice conditions of participation and compliance standards. Reaching out to doctors’ offices on a regular basis.
• Troubleshooting referral issues/concerns and working with leadership to streamline and improve experience for referring agencies/MDs/etc.
• Maintaining up-to-date knowledge of all related standards and requirements for new patients. Collaborating with Clinical Leadership to ensure all accepted patients are clinically appropriate for Home Health / Hospice Services.
• Collaborating with clinical staff to ensure all patients are seen in a timely manner and in accordance with physician orders.
• Participate in quality improvement and change management procedures and processes.
• Own and regularly review DNBs and Stop Bills to ensure appropriate billing.
• Maintaining HARs (Hospital Account Records) and closing when appropriate.
• Maintain regular contact with all patients on caseload. Consistently verify that services are going well, that patient is safe at home, and that all inquiries are addressed timely.
• Utilize Midas for safety event and compliance reporting.
• Participate in agency Interdisciplinary Team meetings.
• Participate, as needed, in Emergency Operations, Forms Committee, Home Health / Hospice QAPI.
Overall, under the direction of the Leader/Director, shall work closely with Other appropriate departments.
This position does not provide patient care.