Support Services Coordinator

Support Services Coordinator

Support Services Coordinator
Tracking Code
305254-763
Job Description

The Support Services Coordinator (SSC) assists the Care Manager (CM) in the development, processing and completing all service determinations that the CM is responsible for.  
Goal:
To insure the quality of the communication with the providers and to help expedite the review process, and insures that policy and procedures, as well as, Medicare criteria are followed. The SSC works under the direct supervision of the licensed nurse. The SSC will maintain an organized filing system for proper daily control of the file cabinets and the timely accurate distribution of files; the timely and accurate updating and logging in all request that come in. Is responsible for assisting assigned nursing staff with but not limited to: verifying eligibility, checking benefits, documenting physician direct referrals, pre-certification or authorizations of certain services, subject to the policies and procedures of the IPA, via phone, fax or written requests.
 Responsibilities to include but not limited to:
* SSC will make initial contact with the provider that sent request and notify them that the request has been received and the name and direct phone number of the Nurse Reviewer.
* SSC will check eligibility on each member a request is received on,
* Will follow the Health Services department’s policies for documentation and communication to team members, providers and members.
* SSC will tract all request that receive a 14 day extension letter
* Responsible for gather information to assist the clinical staff in making a determination.
* SSC will enter all approvals and denials in Facets Prospective UM.
* Will be trained on research and will be available to assist the Medical Manger with Medicare Criteria research if required.
* SSC will maintain the management of files in the file cabinets to include the pulling and filing back of files
* SSC will insure timely processing of incoming documents into the files for logging in the spread sheet and distribution to assigned Nurses
* process active and inactive medical records files every six months for purging and off site storage and/ or entering them into Macess
* assist with other responsibilities as requested
* Handles incoming calls from physicians, ancillary provider, and members for referral authorizations or pre-certifications of medical services.
*  Assists IPA physicians and staff with locating contracted provider and answering questions regarding the authorization process.
* Reviews all incoming fax requests for pre-certification or referral authorizations for completeness of information provided.
* Ensures that network providers are utilized. Obtains CPT procedure codes, ICD-9 diagnosis codes, so that determination or approval/denial of services may be made by a licensed professional.
* Performs data entry of referral authorization, outpatient surgeries, inpatient procedures and admissions.
* Defers authorization requests to appropriate medical staff for review as needed.
* Transmits via facsimile all referrals or authorization requests to the physician, facility or payor, files requests in client files after data is entered into computer.
* Monitor and facilitate reauthorization requests for home health, DME and other services according to guidelines.  Coordinates out of network referrals to specialists with Medical Director.
* Perform other duties as assigned by Director.
Has direct responsibility for compliance with the Sarbanes-Oxley Act in matters of financial and operational controls and disclosure requirements as mandated by the Act. This includes strict adherence to the company’s Business Conduct Statement and Code of Ethics. The emphasis will be on compliance with financial procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
Required Skills

* Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner.
* Computer literacy in Word, Excel and Outlook.
* Strong analytical, organizational and time management skills, able to work with little supervision while handling numerous projects at once.
* Excellent written/verbal communication skills, especially the ability to communicate effectively in stressful situations. 
* Computer literature and familiar with medical terminology.  Must process a background in CPT procedure and ICD-9 coding and the authorization /pre-certification process
Required Experience

Experienced Required:
* Healthcare related experience is preferred.
* Minimum of 2 years in the office clerical or insurance industry and organizational skills, spelling a must.
* To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/ or ability required. 
 
 Education/Certifications:
* High school graduate or equivalent
Job Location
Houston, TX, US.
Position Type
Full-Time/Regular