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LPN Payor Specialist - Case Management - FT Days

Company: CHI St. Vincent
Location: Little Rock
Posted on: November 9, 2019

Job Description:

Position Type: RegularScheduled Hours per 2 week Pay Period: 80Primary Location: AR > LITTLE ROCK > ST VINCENT INFIRMARY JOB SUMMARY: Primary responsibility is to function in a support role for the case management department to efficiently communicate with payors to ensure timely initial stay authorization and continue stay authorizations for acute care inpatients. The Payor Specialist effectively communicates clinical information and negotiates with payors to obtain pre-auth, pre-cert, and continued stay authorization for appropriate levels of care and length of stay.ESSENTIAL FUNCTIONS: Serves as a resource to case management for severity of illness (SI) and intensity of service (IS) determinations, including observation, admission status. Provide prompt payor feedback to Case Management/Social Work, enabling them to re-evaluate/re-direct the current patient plan of care in order to streamline the delivery of service. Obtains payor certification for unplanned admission, home care, and post-acute services as required. Enters and maintains certification information on the appropriate system. Provides educational programs a minimum of two times biannually or as needed regarding payor guidelines and current managed care issues. Provides information about cost of alternative care setting to enhance cost/benefit analysis process. Proactively identifies, documents, and communicates to Case Manager as appropriate. Communicates with on site reviewer. Verifies all funding sources have been explored including charity. Ensures payor and customer satisfaction through effective communication and positive guest relations skills at all times. Tracks and trends utilization outcomes data to negotiate with payors on a case-by-case or contractual basis. Maintains, updates, and disseminates payor grid. Participates in Process Improvement initiatives Updates the Case Manager information either manually or electronically on a daily basis to accurately reflect each Case Manager's outstanding reviews Provides data entry and report generation of indicator data as directed. Performs other related functions as directed.MINIMUM QUALIFICATIONS:Education: High school degree with at least five years healthcare experience or Associate Degree in healthcare related field with three to four years experience. Will have completed internal or external medical technology course within six months or, relevant clinical experience.Experience: Expertise and knowledge of third party payor, Medicare/Medicaid guidelines. Experience with office machines (ie copier, fax, telephone), computer terminal/personal computer, software (ie word processing, spreadsheets, etc.)Physical Requirements: Occasionally requires light physical effort as in periods of standing at files or worktables, repeated changes in position within the work routine or prolonged sitting.Skills: Computer skills, communication skills, prefer experience in post acute activities such as awareness of home care, nursing home, IV infusion companies, LTAC's. Interpersonal and communicative skills to effectively deal with a variety of people including physicians, administrative directors, nursing staff, patients, and family members Additional Information

  • Requisition ID: 2019-R
  • Schedule: Full-time
  • Shift: Day Job
  • Market: CHI St. Vincent

Keywords: CHI St. Vincent, Little Rock , LPN Payor Specialist - Case Management - FT Days, Healthcare , Little Rock, Arkansas

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