Hours: Monday - Thursday 8 am-6:30 pm
The Throughput/Discharge Assistant
Prioritizes work to maintain workflow functions as needed. Fields faxes voicemails written correspondences categorizes and disseminates mail.
Arranges and documents P2P requests post P2P determinations denial and approval information from payors; provides missing or updated demographical/clinical information needed for authorization determinations; on front line of appeals process communicates with payors Carilion billing department and UM team for appeals case submissions; explores inquiries regarding benefits coverage and insurance questions. Assists Central Resource Center (CRC) staff with certain workflows e.g. regulatory letters and Virginia MLTSS (UAI) approval process as needed.
Maintains databases and spreadsheet files ensuring accuracy production and distribution; manages Epic work queues with appeals denials and P2Ps and tracks related data.
Researches and resolves issues and concerns ensuring a timely turnaround to facilitate throughput.
Supports regulatory tasks that are federally mandated such as the Medicare Important Message (IM) Lifetime Reserve (LTR) Day and Status Change letters.
Aids in completion of demographic information to facilitate delivery of in person letters to patients (IM observation to IP LTR and Code 44 etc.).
Collaborates with team and Carilion billing to verify and add LTR day information to letters for delivery.
Receives Notice of Medicare Non-Coverage (NOMNC) letters for patients that are in swing beds and disseminates to all Care Management team members in a timely manner.
Documents delivery in patients electronic medical record and notifies billing department as appropriate.
Provides letter delivery at regional facilities as needed.
Processes health plan specific referral requirements including prior authorizations and assists with denial/appeal resolutions as well as P2P initiations related to admission and throughput needs.
Resource/liaison to payors billing staff patients and providers. Answers phone calls re: pricing benefits coverage approvals denials and insurance questions.
Facilitates timely collection of paperwork signatures and other correspondence from the Care Management team and external agencies required to facilitate a timely discharge.
Assists medical and nursing staff as needed.
Travels between regional facilities to support and facilitate timely patient progression/ throughput needs.
Education: Associate degree or 2 years of experience can be considered in lieu of degree.
Experience: 2 years of experience in data collection and analysis and/or advanced administrative support required.
Licensure certification and/or registration: Virginia MLTSS (UAI) Certification required.
Other Minimum Qualifications: Advanced computer skills with knowledge of a variety of software programs including Microsoft word Excel Access word processing spreadsheets and presentation or database software. Excellent communications and organizational skills required.
This job description is only meant to be a representative summary of the major responsibilities and accountabilities performed by the incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
Recruiter:
DANA JOHNSONRecruiter Email:
For more information contact the HR Service Center at 1-.
Carilion Clinic is an Equal Opportunity Employer: We provide equal employment opportunities to all employees and applicants without regard to race color religion sex national origin age (40 or older) disability genetic information or veterans status. Carilion is a Drug-Free Workplace. For more information or for individuals with disabilities needing special assistance with our online application process contact Carilion HR Service Center at 8:00 a.m. to 4:30 p.m. Monday through Friday.
Required Experience:
Junior IC