<p>Job Summary:</p> <p>Responsible for supporting all non-clinical functions throughout the Continuum. Supports daily activities of Case Managers and Physicians. Ensures data integrity related to all applicable in-scope inpatient and outpatient services. Coordinates data input, analysis, and reporting for KPGA Continuum utilization management, continuing care services, case management, and outside services management.</p> <p>Essential Responsibilities:</p> <ul> <li>Supports all non-clinical functions throughout the Continuum. </li><li>Facilitates discharge planning for members across the Continuum. </li><li>Answers phones to respond to all inquiries made by patients, vendors, and other healthcare recipients. Must be able to handle at least 100-150 calls per day. </li><li>Must be able to work in a call centric environment and meet daily metrics. </li><li>Must be able to work in a productivity driven environment to meet the need of members and providers. </li><li>Enters authorization/referral data into required applications for all levels of care, ensuring the correct admitting, principal, and discharge diagnoses, bed types, discharge date, and other applicable fields. </li><li>Ensures accuracy of Tapestry Census Reports by reviewing/updating authorizations daily and attending case management rounds to update diagnoses or other information as needed or indicated. </li><li>Documents outside medical services and enters referrals into Tapestry for all applicable levels of care. </li><li>Ascertains eligibility and benefits for all admissions and every 7 days thereafter (or other designated time frame). </li><li>Ascertains admission status via physician order for weekend retro admissions, enters authorization, and sends to CM/UM for review. </li><li>Coordinates data and reporting needs, data collection process, and data processing issues; provides timely utilization data and analytic support. </li><li>Collaborates with other organizational units and outside facilities to obtain, verify, and/or provide information, e.g. works with KP Claims and external vendors to reconcile billed charges. </li><li>Answers inquiries and educates members, physicians, and hospitals on covered benefits and other related topics. </li><li>Provides information and assistance to members during claims review process and coordinators authorized and non-authorized claims review. </li><li>Coordinates and supervises air and ground transportation and authorization review for said services. </li><li>Coordinates durable medical equipment for members. </li><li>Maintain the consistency and integrity of all applicable utilization tracking management systems. </li><li>Schedules member appointments and coordinates care as needed. </li><li>Determine admission status via MD order for weekend retro admissions, enter authorization & forward to ICM for review. </li><li>Work pended claims in Tapestry pool, forwards to appropriate Continuum staff for investigation as needed and pend back to claims pool when completed. </li><li>Run, print, and make copies of Tapestry census for rounds. Attend case rounds with Continuum staff & Physicians. </li><li>Copy required sections of members charts for referrals to all levels of care and place on front of chart as requested by Case Manager/Utilization Reviewer. </li></ul>