Coordinator- Integrated Transitional Care 24-00727 - Alura Workforce Solutions

Title

Coordinator- Integrated Transitional Care

Schedule: M-F, 8:00 am – 5:00 pm, Hybrid (2 days remote 3 days onsite)

DESCRIPTION

Under the general direction of the Manager and Supervisor in the Integrated Transitional Care department, the Coordinator - Integrated Transitional Care is a high paced position that requires timely processing of Authorization requests, verifying eligibility, obtaining additional information as requested by the Integrated Transitional Care Nurse. This position requires that one be organized with the ability to multitask with a working knowledge of ICD 10, CPT coding and Medical Terminology. The Coordinator - Integrated Transitional Care will work as an extension of the clinical team to complete all non-clinical functions as indicated, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships.
1. Monitor the Right Fax server, EDI Interface, and medical management system intake to all face sheets are processed in a timely manner.
2. Ensure that hard copy and electronic face sheets are complete and accurate to reflect current Member demographic information.
3. Review of the daily census report to eliminate duplicates or other admission received from all contracted and non-contracted facilities not required by the health plan.
4. Cover Cisco ACD Queue telephone lines and phone queues.
5. Check eligibility and assigning Authorization to appropriate ITC nurse based on the Far tool.
6. Attach reviews and orders into the medical management system for review by the ITC nurse
7. Review and approve service requests within the ITC Coordinator scope as indicated by the Utilization Management Guide approved by the Utilization Management Subcommittee.
8. Obtain Member discharge dates through daily calls, Electronic Medical Record or memo submissions to contracted and non-contracted facilities.
9. Meet the performance measurement standards for productivity and accuracy as well as timely processing of inpatient authorizations, inpatient service requests, and discharges.
10. Assist with the referral process by contacting provider by phone fax or email to request additional medical information as needed.
11. Set up hospital follow up appts for Member if needed and providing that information to the Member. Documenting the call within the medical management system.

REQUIREMENTS

• Minimum of two (2) years of experience as a data entry specialist
• High School Diploma or GED required
• Must have a valid California Driver's License
• Requires knowledge of ICD 10 and CPT codes
• Managed Care or physician office a must
• Skilled with computer applications, including word processing, database, and spreadsheets
• Knowledge of basic inpatient and outpatient service request
• Knowledge in Electronic medical records
• Customer service experience, knowledge speaking with members/clients
• Knowledge of Electronic fax

INDH