This position is responsible for the coordination of Referral/Precertification Management information between the UM/CM Department and providers via telephone and/or faxed clinical information. This position also performs selected data entry as submitted by medical providers.
Receive, process and complete data entry of demographic information for all referral and authorization requests from providers via fax or phone and as appropriate, forward to precertification nurse/care manager/case manager.
Begin on-line process utilizing skills of typing, medical terminology and ICD/CPT coding.
Request, document and forward out of network provider demographic information to PR Department and update case when appropriate
Using internal scripts, process auto-approve requests per department procedures
Begin on-line process of above, utilizing skills of typing, medical terminology, and ICD/CPT coding
Coordinate daily review activity for on-site case managers
Data entry of daily census, INN emergency room logs, and designated referrals/authorizations per management directive
Assist in maintaining files for department
Providing backup coverage for Staff Support Assistant
Scan electronically attach notes and notify appropriate staff for follow up
Adhere to URAC, NCQA and other regulator standards
Communication, Collaboration and Coordination with all customers, internal and external
Collaborate with and maintain open communication with all other departments as appropriate and required to facilitate completion of tasks/goals
Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
Attend monthly departmental meetings and/or interdepartmental meetings as appropriate
Ability to sit for long periods of time.
Ability to organize and prioritize work to meet deadlines.
Ability to work occasional long or irregular hours.
Good speaking ability, judgment, and initiative
Ability to work a flexible work schedule including evenings and weekends
Our Mission: WHY WE EXIST. To extend the healing ministry of Jesus Christ. Our Core Values: WHAT WE BELIEVE IN.DIGNITY Respect for the worth of every person, recognition and commitment to the value of diverse individuals and perspectives, and special concern for the poor and underserved. INTEGRITY Honesty, justice, and consistency in all relationships. EXCELLENCE High standards of service and per...formance. COMPASSION Service in a spirit of empathy, love, and concern. STEWARDSHIP Wise and just use of talents and resources in a collaborative manner.Our Vision: WHAT WE ARE STRIVING TO DO. CHRISTUS HEALTH, a Catholic health ministry, will be a leader, a partner and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God's healing presence and love. Our Name and Symbol:WHO WE ARE. CHRISTUS is Latin for "Christ," and proclaims publicly the core of our mission. OUR NAME choice also recognizes the heritage of our two congregational sponsors, the Sisters of Charity of the Incarnate Word in Houston and San Antonio. Jesus Christ is the Incarnate Word, the Word of God made flesh. It is, therefore, only fitting that it is in another form of His name that our health ministries are called together. OUR SYMBOL Reflects the healing ministry of Jesus Christ - a combination of a medical cross and a religious cross. The flowing banner on the cross is a common symbol of the risen Christ, while the royal purple signifies Christ. The flowing banner also conveys a sense of motion as we move forward into a new era of service to our communities.