Inpatient Coordinator

Summary

This position works collaboratively with other members of the Clinical Care Coordination team to ensure that authorization requests, provider and member inquiries are handled appropriately, within established timeframes and utilizing established guidelines.

Job Responsibilities

• Sorts hospital face sheets received via Right Fax.
• Archives face sheets and clinical reviews received in EZ Cap.
• Sorts and create retro reviews requests received via mail or fax.
• Verifies patient’s eligibility via email to Eligibility Department to check for primary and secondary insurance.
• Generates tracking number in EZ Cap through Hospital face sheets.
• Sends inpatient census to different hospitals
• Forwards face sheets of patients below 21 years of age to CCS Coordinators.
• Generates daily inpatient bed day logs for all IPAs.
• Call hospitals and check if patients listed on the daily bed day logs are still in-house; if discharged, call medical records/admitting department for discharge dates and document it in EZ-cap.
• Distributes bed day logs to all nurses and Medical Directors via email.
• Generates and forward bed day logs to designated clinics or capitated hospital recipients.
• Receives/Answers inpatient queue lines.
• Retrieves inpatient queue’s voicemail messages and return calls.
• Forwards hard copy of authorizations to requesting hospitals and skilled nursing facilities.
• Assists the nurses as needed for non-clinical tasks (i.e. checks premanage, look for inpatient medical records in right fax, etc).
• Covers and assists other Inpatient Coordinators as needed.
• Checks re-admission for each patient and notify Re-admission Department, Nurse Case Managers and Transition of Care Coordinators.
• Verifies patient admit source and discharged disposition
• Checks the Health Plan website or call the Health Plan for inpatient authorization status as needed.
• Sends e-mail to Uploads Department to add the hospitals that are not yet in EZ Cap.
• Calls hospital to verify if member was admitted as observation or inpatient
• Calls hospital to verify admitting Doctor if not listed in the face sheet

Position Requirements:

• Required a High School or GED.
• Preferred an Associate’s Degree in a related field.
• Required 3 years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties.
• Intermediate knowledge of medical terminology and/or experience with CPT and ICD-10 coding.
• Intermediate demonstrated interpersonal/verbal communication skills.
• Intermediate demonstrated written communication skills.
• Intermediate ability to effectively present information and respond to questions from peers and management.
• Intermediate ability to multi-task.
• Intermediate ability to work effectively within group to achieve desired outcomes.
• Required intermediate Microsoft Outlook Proficient in Microsoft Office such as Outlook, Word and Excel.
• Required Intermediate Microsoft Excel.
• Required Intermediate Microsoft Word.