MedStar Health
Overview
2 days ago Be among the first 25 applicants General Summary Of Position: Collaborates with and assists the multidisciplinary team to meet individualized patient outcomes. Performs admission and subsequent concurrent reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Responsibilities
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. Actively participates in ongoing professional enrichment and educational opportunities. Collaborates with and assists the multidisciplinary team to meet the patients\' continuing health needs in a high quality, cost-effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient, LOS, insurance, and discharge needs. Integrates and evaluates discharge planning needs with the multidisciplinary team to ensure a positive patient outcome. Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement, risk management, safety, infection control, and other departments as appropriate. Confers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care. Collaborates with outpatient providers to provide continuum of care for community resources. Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity. Identifies insurance information, obtains authorization, communicates with financial counseling, and assigns appropriate length of stay for admission. Identifies in-network providers for discharge planning needs and facilitates appointments. Collects data in collaboration with Case Management to support the appeal process. Implements strategies to avoid denials including potential denial notification to the attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to the multidisciplinary team. Ongoing collaboration routinely with Social Work and physicians for continued update and revision of discharge plan to provide appropriate utilization of resources and to ensure optimal patient outcomes. Performs admission and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age-specific needs. Interacts with and assists third party payer reviews to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources. Collects data in collaboration with third party payers to ensure appropriate use of resources. Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services, staff meetings, orientation, and formal educational offerings. Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multidisciplinary quality and service improvement teams. Qualifications
Minimal Qualifications
Education
Associate\'s degree in Psychiatry or related field required or Experience
5-7 years Clinical experience in acute care setting preferred; and 1-2 years Experience in utilization/discharge planning, required Knowledge, Skills and Abilities
Verbal and written communications skills Organizational and problem-solving skills Working knowledge of various computer software Compensation
This position has a hiring range of USD $20.57 - USD $36.27 /Hr. Note:
This posting includes referrals increase your chances of interviewing at MedStar Health by 2x. Get notified about new Medical Records Technician jobs in Baltimore, MD. Job Details
Seniority level: Not Applicable Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care Halethorpe, MD $82,824.50 - $115,452.70 We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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2 days ago Be among the first 25 applicants General Summary Of Position: Collaborates with and assists the multidisciplinary team to meet individualized patient outcomes. Performs admission and subsequent concurrent reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Responsibilities
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. Actively participates in ongoing professional enrichment and educational opportunities. Collaborates with and assists the multidisciplinary team to meet the patients\' continuing health needs in a high quality, cost-effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient, LOS, insurance, and discharge needs. Integrates and evaluates discharge planning needs with the multidisciplinary team to ensure a positive patient outcome. Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement, risk management, safety, infection control, and other departments as appropriate. Confers and collaborates routinely with the physician advisor, division chiefs, and attending physicians to resolve problems regarding acuity and level of care. Collaborates with outpatient providers to provide continuum of care for community resources. Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity. Identifies insurance information, obtains authorization, communicates with financial counseling, and assigns appropriate length of stay for admission. Identifies in-network providers for discharge planning needs and facilitates appointments. Collects data in collaboration with Case Management to support the appeal process. Implements strategies to avoid denials including potential denial notification to the attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to the multidisciplinary team. Ongoing collaboration routinely with Social Work and physicians for continued update and revision of discharge plan to provide appropriate utilization of resources and to ensure optimal patient outcomes. Performs admission and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age-specific needs. Interacts with and assists third party payer reviews to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources. Collects data in collaboration with third party payers to ensure appropriate use of resources. Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services, staff meetings, orientation, and formal educational offerings. Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multidisciplinary quality and service improvement teams. Qualifications
Minimal Qualifications
Education
Associate\'s degree in Psychiatry or related field required or Experience
5-7 years Clinical experience in acute care setting preferred; and 1-2 years Experience in utilization/discharge planning, required Knowledge, Skills and Abilities
Verbal and written communications skills Organizational and problem-solving skills Working knowledge of various computer software Compensation
This position has a hiring range of USD $20.57 - USD $36.27 /Hr. Note:
This posting includes referrals increase your chances of interviewing at MedStar Health by 2x. Get notified about new Medical Records Technician jobs in Baltimore, MD. Job Details
Seniority level: Not Applicable Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care Halethorpe, MD $82,824.50 - $115,452.70 We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr