Resource Center Associate

Job ID: J124969
Company: West Penn Allegheny Health System
Location: Pittsburgh, PA, United States
Facility: West Penn Hospital
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

GENERAL OVERVIEW:

Coordinates the clerical and administrative processes of utilization management and discharge arrangements. Completes any other tasks within department guidelines requested by the Care Management Coordinators and Social Workers.

ESSENTIAL RESPONSIBILITIES:

  • Assists with utilization review by identifying patients to be completed and/or closed out; ensures timely transfer of pertinent patient information to third party payers; follows up with third party payers as needed; assists in the acquisition of authorizations for acute and post-acute services; appeal and denial process as needed. (35%)
  • Supports discharge plan implementation under direction of the care coordinator and social worker, which may include but not limited to: faxing to payers/post-acute providers; calling vendors, physician offices, clinics, etc.; arranging for durable medical equipment; facilitating transfers and transportation; coordinating and scheduling home health needs; identifying community resources; completing appropriate discharge documentation; identifying primary care physicians and scheduling PCP/specialty appointments as needed; updating patient
    demographic/billing data; assisting with placement process. (55%)
  • Collects/enters data as directed and performs other administrative duties as needed. (5%)
  • Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies. (5%)
  • Performs other duties as assigned or required.

QUALIFICATIONS:

Minimum

  • High school diploma or GED; or six months to one year related experience and/or training; or equivalent combination of education and experience.
  • 3-5 years of relevant experience, proficient computer skills with experience in: Microsoft office, internet navigation, clinically- based software, and financially-based software.
  • Knowledge of medical terminology.

Preferred

  • Associate's Degree from a business/secretarial school or program.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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