Key Facts

Remote From:

Full time

Expert & Leadership (>10 years)

English

Hard Skills

Nurse Licensure Compact Health Reimbursement Arrangement Medicare Industry Trend Analysis Medical Privacy Electronic Referrals Diagnosis Codes Clinical Research Coordination Adobe Creative Cloud Internet Services +3 more

Other Skills

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Microsoft Excel
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Microsoft Word
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Communication
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Assertiveness
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Teamwork
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Time Management
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Detail Oriented
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Willingness To Learn

Roles & Responsibilities

Active RN or LPN license.
Experience coordinating referrals, admissions, and home health care processes.
Strong communication and collaboration skills with external referral resources.
Proficiency with Microsoft Word, Excel, Adobe, and E-Fax; ability to track documentation and maintain reports.

Requirements:

Receive, review, and monitor new referrals to determine ability to accept or decline and assess clinical appropriateness and homecare needs.
Collaborate with multiple internal and external teams to ensure patient success in the homecare setting and troubleshoot missing or incomplete documentation needed for new admissions.
Coordinate with Authorizations and clinical management on insurance, reimbursement, billing, and potential new contracts; obtain verbal orders for admissions and fax written orders when verbal orders cannot be obtained.
Maintain CMS F2F requirements and Pre-Claim Review (PCR) performance, track accept/decline reports, maintain confidentiality, and participate in team meetings and policy development; utilize office software.

Job description

Summit Home Care and Hospice is searching for an experienced and motivated Clinical Referral Coordinator to join our team! At Summit we’re committed to providing comprehensive healthcare services in the comfort of our patients' homes to positively impact quality of life by redefining the delivery of care.

Clinical Referral Coordinator:

Shift: Dayshift, Monday – Friday (40 Hours/Week) & Weekend/Holiday Rotation
Pay Rate: $24.00 - $28.00 per Hour
Location: 800 Yard St. Suite 300 Grandview Heights, OH 43212
Work Setting: On-Site with Remote Opportunity After 6 Months

Responsibilities:

Receive, review, and monitor new referrals to determine ability to accept or decline.
Accurately determine and anticipate homecare needs and accept and decline on clinical appropriateness.
Assists in interpreting operational indicators to detect census changes and increases or decreases in volume, which could impact staffing levels, revenues, or expenses.
Adheres to the agency’s Acceptance to Service Policy.
Collaborate with multiple teams, both internal and external, to ensure patient success in the homecare setting.
Demonstrate professional assertiveness when communicating with external referral resources.
Report and/or troubleshoots missing or incomplete documentation or visit notes needed for new admissions.
Works with Authorizations and clinical management team when new insurances are identified to determine reimbursement, ability to bill and if new contract is needed.
Call for, follow up on, track and obtain verbal orders for admissions.
Fax written orders for signature for admissions when verbal order unable to be obtained.
Ability to track, trend and maintain accept/decline reports.
Ability to identify primary and secondary billable diagnosis.
Understand and adhere to F2F requirement regulated by CMS.
Ability to maintain Pre-Claim Review (PCR) of no less than 97% (While participating in PCR as an agency).
Utilize office and other patient care software, including Microsoft Word, Excel, Adobe, and E- Fax.
Maintain confidentiality of information related to patient and organization.
Perform interdepartmental and external communication.
Engage in team meetings and provide feedback.
Develop and implement organization policies and procedures under guidance of supervisor(s).
Attend in-person training and meetings when necessary.
All other duties as assigned by supervisor(s).