Summary 1. The individual in this position works under direction of Social Worker or Case Manager RN. 2. The individualâ��s responsibilities include but not limited to the following actions: 3. Follow up on patient accounts for when authorization for stay is required 4. Fax numbers to Send clinical reviews 5. Follow up on each account during the stay and on discharge for authorization - document in the electronic system 6. Escalate any potential disputes or denial of accounts to director of Case Management or designee 7. 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) 8. Trend by payor and service any authorization not obtained by end of day 9. Trend and Track on denial prevention 10. Other duties as assigned
Responsibilities 1. Utilization Management 2. Validates patientâ��s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed 3. 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 4. 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 5. 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 6. Provides patients and families with choices of post-acute providers per Tenet policy 7. Responds to post-acute providers timely and completes referrals per Tenet policy 8. 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 9. Completes tasks as assigned by RN or LVN Case Manager and/or SW staff 10. 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 11. Documents all referrals and tasks in the Tenet Case Management system per Tenet policy 12. Education - Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options 13. Compliance - Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services 14. Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies
Education Required: High School Graduate or equivalent Preferred: Associates or Bachelors degree
Experience Required: Two (2) years of experience in clerical or healthcare field. Preferred: Acute hospital experience.
Certifications Preferred: Paramedic, EMT or Certified Nursing Assistant
Primary Location: Framingham, Massachusetts
Facility: MetroWest Framingham Union Hospital
Job Type: Full-time
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: 2105023366
About MetroWest Framingham Union Hospital
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.