The individual in this position works under direction of RN Case Manager and/or Social Worker. The individualâ��s responsibilities include but are not limited to the following actions : a) Follow up on patient accounts when authorization for stay is required , Fax numbers to Send clinical reviews b) Follow up on each account during the stay and on discharge for authorization - document in the electronic system, c) Escalate any potential disputes or denial of accounts to Director of Case Management or designee d) 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) other duties as assigned.
PERFORMANCE METRICS AND EVALUATION The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist. 1. Excess Days/ALOS 2. Clinical disputes - incidence and dollars 3. Number and type of avoidable days 4. Position documentation and productivity
The requirements listed below are representative of the knowledge, skill, and/or ability required. In accordance with The Americans with Disabilities Act (ADA), it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodations will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization.
Minimum Education: High School diploma or equivalent required. Associate or Bachelorâ��s degree preferred.
Minimum Experience: Acute hospital experience preferred. Skills required include excellent organizational skills, excellent verbal and written communication skills, demonstrated problem solving skills, and computer literacy. Data Analytic skills preferred
Required Certifications/Registrations/Licenses: Paramedic, EMT or Nursing Assistant certification preferred.
Primary Location: Rock Hill, South Carolina
Facility: Piedmont Medical Center
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: 2105010047
About Piedmont Medical Center
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.