Description: Job Summary:

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.

Essential Responsibilities:

• Supports all non-clinical functions throughout the Continuum.
• Facilitates discharge planning for members across the Continuum.
• 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.
• Must be able to work in a call centric environment and meet daily metrics.
• Must be able to work in a productivity driven environment to meet the need of members and providers.
• 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.
• 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.
• Documents outside medical services and enters referrals into Tapestry for all applicable levels of care.
• Ascertains eligibility and benefits for all admissions and every 7 days thereafter (or other designated time frame).
• Ascertains admission status via physician order for weekend retro admissions, enters authorization, and sends to CM/UM for review.
• Coordinates data and reporting needs, data collection process, and data processing issues; provides timely utilization data and analytic support.
• 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.
• Answers inquiries and educates members, physicians, and hospitals on covered benefits and other related topics.
• Provides information and assistance to members during claims review process and coordinators authorized and non-authorized claims review.
• Coordinates and supervises air and ground transportation and authorization review for said services.
• Coordinates durable medical equipment for members.
• Maintain the consistency and integrity of all applicable utilization tracking management systems.
• Schedules member appointments and coordinates care as needed.
• Determine admission status via MD order for weekend retro admissions, enter authorization & forward to ICM for review.
• Work pended claims in Tapestry pool, forwards to appropriate Continuum staff for investigation as needed and pend back to claims pool when completed.
• Run, print, and make copies of Tapestry census for rounds. Attend case rounds with Continuum staff & Physicians.
• 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.

Basic Qualifications:
Experience

• Minimum two (2) years of relevant experience.

Education

• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• Certified Professional Coder within 6 months of hire OR Certified Outpatient Coder within 6 months of hire OR Certified Coding Specialist within 6 months of hire

Additional Requirements:

• Able to apply critical thinking, analytic techniques, problem solving, and computer skills to all inpatient and outpatient data.
• Strong analytic and communication skills (written and verbal)
• Expertise with tracking, spreadsheets, and graphic computer systems operating on PC mainframes.
• Knowledge of health plan benefits
• Understanding of medical center operations, complex health systems, with the ability to quickly grasp and apply policies and procedures.
• Data entry experience.
• Working knowledge and use of the most up-to-date ICD manual, as well as CPT/HCPCS codes.
• Understanding of health care payment mechanisms (capitation, fee-for-service, etc.)
• Functional knowledge of computers, fax machines, and copiers.
• Excellent customer service skills.
• Proficient with Microsoft Office Suite (Word, Excel, PowerPoint, etc.).

Preferred Qualifications:

• Clinical background preferred.
• Medical Terminology Certification preferred.
• Bachelors degree.

Primary Location: Georgia,Atlanta,Regional Office - 9 Piedmont
Scheduled Weekly Hours: 32
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 09:00 AM
Working Hours End: 06:00 PM
Job Schedule: Part-time
Job Type: Standard
Worker Location: Remote
Employee Status: Regular
Employee Group/Union Affiliation: NUE-GA-01|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Regional Office - 9 Piedmont - Utilization Management - 2808
Pay Range: $36400 - $47080 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No
Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest

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