The individual in this position works under direction of Social Worker or Case Manager RN. The individualï¿½s responsibilities include but not limited to the following actions: Follow up on patient accounts for when authorization for stay is required Fax numbers to Send clinical reviews Follow up on each account during the stay and on discharge for authorization - document in the electronic system Escalate any potential disputes or denial of accounts to director of Case Management or designee Trends disputed claims by at least payor and physician (e assist in obtaining authorization for patient discharged to Skilled Facilities or other post acute care that require authorization) Trend by payor and service any authorization not obtained by end of day Trend and Track on denial prevention Other duties as assigned
Validates patientï¿½s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed
Validates that all commercial/managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) of variances
Provides Important Message follow up letter to Medicare patients per Tenet policy and under the direction of the RN Case Manager or SW Transition Management
Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the electronic Tenet Case Management system
Provides patients and families with choices of post-acute providers per Tenet policy
Responds to post-acute providers timely and completes referrals per Tenet policy
Documents and communicates all elements of the post-acute referral to the RN Case Manager or SW and the healthcare team, patient/family and post-acute providers
Completes tasks as assigned by RN or LVN Case Manager and/or SW staff
Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers
Documents all referrals and tasks in the Tenet Case Management system per Tenet policy
Education - Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options
Compliance - Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services
Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies
Required: High School Graduate or equivalent Preferred: Associates or Bachelors degree
Required: Two (2) years of experience in clerical or healthcare field. Preferred: Acute hospital experience.
Preferred: Paramedic, EMT or Certified Nursing Assistant
Primary Location: San Antonio, Texas
Facility: Baptist Health System
Job Type: PT2Y
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 2005039374
About Baptist Health System
Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.
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