Job Description

Overview



Baptist Health System Hospital is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients.

At Baptist Health System, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

Job Summary

The individual in this position works under direction of RN Case Manager and/or Social Worker. The individual’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 f) other duties as assigned

Responsibilities

General Functions

Utilization Management

 Validates patient’s demographic and payer information with patient/family and notifies Patient Access

immediately if any corrections are needed

 Validates that all commercial/managed care discharges have an authorization for status and level of care

provided and notifies Director of Case Management (DCM) or designee of variances

 Cases that require authorization are obtained daily by fax or phone and documentation is completed daily

 Escalate discharged cases at end of day that have no authorization or notification of dispute is provided by payor

 Concurrently make sure all clinical needed by payors and updates are provided by alerting Case Manager

assigned to case and escalating to DCM if not completed timely

 Trend dispute/denial potential to DCM or designee by failure points in revenue cycle

 Prepare denial information for UR Committee, Denial and Revenue Cycle Meetings

 Collaborate with Patient Access, Case Management, Managed Care and Business office to improve concurrent

review process to avoid denial or process delays in billing accounts (85% daily, essential)

Transition Management

 Follow up on Authorization for post-acute services

 Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff

utilizing the Tenet Case Management documentation system

 Follow-up if referral requires an authorization by payor to discharge the patient

 Completes tasks as assigned by RN or LVN Case Manager and/or SW staff

 Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate

hospital information is communicated to post-acute providers

 Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet policy 

Provides Important Message follow up letter to Medicare beneficiaries per Tenet policy and under the direction of

the RN Case Manager or SW (10%daily, essential)

Compliance

 Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of

services

 Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of

Participation and Tenet policies (5% daily, essential

Qualifications

MINIMUM EDUCATION: High School diploma or equivalent required.

PREFERRED EDUCATION: Associate or Bachelor’s degree

MINIMUM EXPERIENCE: Must have excellent organizational skills, excellent verbal and written communication

skills, demonstrated problem solving skills, and computer literacy.

PREFERRED EXPERIENCE: Acute hospital experience. Data Analytic skills.

REQUIRED CERTIFICATIONS/LICENSURE: N/A

PREFERRED CERTIFICATIONS/LICENSURE: Paramedic, EMT or Nursing Assistant

REQUIRED COURSES/ COMPLETIONS: N/A

PATIENT POPULATION/AGES SERVED: (√) Check all that apply

#LI-GF2

Organization Description

Baptist Health System has more than 120 years history of caring for our community and making a positive difference. Our system of care includes six full-service hospitals, a specialized childrens hospital with a dedicated pediatric emergency unit, a comprehensive cancer care network, fitness and rehabilitation centers, a physician network, imaging centers, ambulatory services and the Baptist School of Health Professions. Wherever you go in the Baptist Health System, youll find that we have the same goal to help people achieve health for life through compassionate service inspired by faith. Join our team!

Employment practices will not be influenced or affected by an applicant’s or employee’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.

Tenet participates in the E-Verify program. Follow the link below for additional information.

E-Verify: http://www.uscis.gov/e-verify

The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.

2603022127