Job Category:

Clinical Support

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Responsible for processing referrals and scheduling admission visits per Hospice of NGMC policies and procedures. Interacts with physicians, administration, payer sources, supervisors and staff as a resource for referrals, admissions requirements, payors and community services. Obtains complete and accurate information and completes requirements to maximize the likelihood of reimbursement. Coordinates initial hospice patient referral and follow-up obtaining appropriate orders, checking information such as verification of benefits, assisting with arrangements for a patient consult or admission and ensuring the accurate completion of the admission chart and closing out past non-admissions. Excellent customer service skills are required in answering the Access Center telephone and triaging calls and navigating the computer and obtaining required information from the hospice's and hospital's software system. Trains and directs Hospice Secretary II position. 

Minimum Job Qualifications

• Licensure or other certifications: State of Georgia Registered Nurse or LPN License

• Educational Requirements: High School Diploma or GED

• Minimum Experience: Two (2) years of healthcare experience for RN; 5 years healthcare experience for LPN

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements: Bachelors Degree

• Preferred Experience: Experience in hospice, oncology, or home health

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Knowledge of state and federal regulations regarding care and reimbursement required with hospice specific knowledge preferred

• Excellent customer service and communication skills, both verbal and written

• Excellent critical thinking and organizational skills. Ability to collaborate well with patients/families, admission staff, physicians, providers, and handling multiple tasks.

• Computer skills to include Microsoft windows, Word, Excel and database knowledge preferred

Essential Tasks and Responsibilities

• Ensures facilitation of the intake and case management process for the hospice service to ensure efficient and effective continuity of care. Processes referrals to assure efficient pre-qualifying of patients. Demonstrates knowledge regarding the scope of services and of policies and procedures of the organization. Communicates effectively with referral sources and team members to support the business partnerships being developed by the organization. Provides excellent customer service, speaking clearly and communicating information in a manner appropriate to the caller/audience. Obtains thorough medical and demographic information on all referrals and ensures optimal communication with patient care coordinator or admitting clinician for smooth transition to organization services. Informs and updates staff of new and pending admissions per organization policy. Calls patients to notify and verify information; obtains directions to patient home. Identifies the need for an interpreter. Consults with attending physician and/or Hospice Medical Director to determine appropriateness of referral for admission to the hospice program based upon Medicare/Medicaid/intermediary requirements and organization admission criteria. Ensures that all possible options are exhausted to assist the referral sources to meet the needs of the patient, even when services are not ordered, or the patient is not eligible for services.

• Ensures accurate and timely processing of all hospice referrals and associated orders and certifications. Ensures that all possible options are exhausted to assist the referrals sources to meet the needs of the patient, even when organization services are not ordered, or the patient is not eligible for services. Refers to other organizations or community resources when referral does not meet criteria for hospice admission. Provides educational opportunities and updates staff on changes in medical and financial requirements regarding hospice admission and coverage. Accepts feedback from staff. Supports the achievement of admission goals by conducting follow up calls on referrals not admitted. Coordinates scheduling of referrals with Admission Nurses, Business Development Specialists and Social Services staff assuring that correct staff is sent to refer or admit.

• Ensures that all Intake information is verified and entered into the clinical information system. Demonstrates knowledge of and ability to operate current software programs, clinical and office. Enters all referrals into the information system and assigns appropriate number. Keeps accurate records concerning referrals and admissions and utilizes the weekly statistical base to analyze the disposition of the referrals. Tracks and trends referrals not admitted to the program. Demonstrates understanding of the ICD-10 coding process and codes all diagnoses prior to processing the referral. Maintains referral source database.

• Maintains knowledge of current Medicare, Medicaid and third-party reimbursement guidelines. Demonstrates knowledge of payor guidelines for all reimbursement sources. Verifies benefits and precert requirements for all commercial insurance clients and begins certification of medical necessity process whenever appropriate. Reviews Medicaid DMA-579 for completeness. Educates referrals sources regarding hospice care and payment resources/hospice benefit covered/non-covered items/services. Reviews and verifies that admission financial documents have been completed accurately. Assists with billing functions to ensure that all necessary documentation is completed/received and that all follow-ups have been completed. Maintains log for all clients requiring insurance case management follow-up and provides updates as needed to continue authorization for services.

• Develops and maintains the database to ensure that orders are accepted only from licensed physicians. Ensures current licensure for all ordering physicians in accordance with policy and procedure of the organization. Reviews and updates database routinely. Maintains proof of licensure on all new physicians and ensures that all physicians are updated. Checks routinely for providers excluded from participating in Medicare/Medicaid program.

• Contributes to the productive and effective operation of the organization. Schedules and assists Admission Nurse in coordination of referral and admission. Works to improve communication and facilitate problem solving between referral sources, payors and Hospice of NGMC. Apprises Access Center Supervisor of entities who express need for improvement in services. Processes referral and admission paperwork and charts and forwards to medical records department. QA's incoming/outgoing paperwork and documents for accuracy and completion. Assists Admission nurse in correctly assigning team staff via zeemaps. Trains and directs activities of Intake Secretary.

• Coordinates admission demographics and billing information with Billing Supervisor. Monitors and works in assigned workques to correct intake errors. Trains and assists intake secretary to maintain admission, referral and billing logs. Communicates to Billing Coordinator any discrepancies in patient billing information. Accurately registers admission and billing information in EPIC.

• Coordinates Weekly Fast Rounds to review referrals, admissions and non-admits. Keeps a running log for review at fast rounds; reviews weekly with Access Center Supervisor. Keeps a log of patients for follow up within the 30-day order window. Maintains Fast Rounds book and conducts weekly meeting with assigned staff.

Physical Demands

• Weight Lifted: Up to 30 lbs, Frequently 31-65%of time

• Weight Carried: Up to 30 lbs, Frequently 31-65% of time

• Vision: Moderate, Constantly 66-100% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Frequently 31-65%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.