HMO Coordinator
2.
7 Lake Katrine, NY Lake Katrine, NY Full-time Full-time $25 an hour $25 an hour 4 days ago 4 days ago 4 days ago Northeast Center for Rehabilitation and Brain Injury is a one-of-a-kind state of the art Skilled Nursing Facility located in Lake Katrine 5 minutes off of exit 19 on the New York State Thruway.
Northeast Center offers programs not found in any other nursing home in the region.
We understand the needs of our staff, which is why we have also created a unique benefits program that our staff have praised, which include:
DAILY PAY RAFFLE PRIZES GIVEN WEEKLY/MONTHLY/ANNUALLY FLEXIBLE SCHEDULING GENEROUS PTO INCREASED PAY RATES REFERRAL BONUSES Whether you're starting your nursing career or looking to advance it, Northeast Center for Rehabilitation and Brain Injury is a place to make your mark in the world! As an HMO Concurrent Review Coordinator, you will play a crucial role in ensuring the smooth and efficient coordination of concurrent reviews for patients in our skilled nursing facility.
You will collaborate with healthcare professionals, insurance providers, and internal staff to optimize patient care and financial reimbursement.
Responsibilities:
1.
Conduct Concurrent Reviews:
Perform ongoing reviews of patient records to ensure compliance with HMO guidelines and regulations.
Collaborate with healthcare providers to gather necessary documentation for the review process.
2.
Communication and Coordination:
Interface with insurance companies to facilitate timely concurrent review and request authorization extension for inpatient care services.
Communicate with the insurance company's assigned nurse care manager to provide the most up-to-date level of care and anticipated discharge plan, ensuring the patient is authorized at the appropriate level of care and for the estimated length of stay.
Communicate with internal teams to streamline information flow and address any issues related to concurrent reviews.
Facilitate, review, and submit the requested documentation for Livanta appeals.
3.
Data Management:
Maintain accurate and up-to-date records of concurrent reviews, authorizations, and communications with insurance providers.
Utilize the specific insurance communication systems and other relevant tools to manage, organize, review, and submit related documentation.
Facilitate the delivery of NOMNCs (Notice of Medicare Non-Coverage) and cut letters in a timely matter.
4.
Compliance and Documentation:
Ensure compliance with all relevant CMS regulatory requirements and HMO policies.
Generate reports on concurrent review activities for internal and the billing department.
Requirements:
Bachelor's degree in healthcare administration, nursing, or a related field.
Previous experience in a similar role, preferably in a skilled nursing facility or healthcare setting.
Knowledge of HMO guidelines and regulations.
Strong communication and interpersonal skills.
Proficiency in using EMR systems and other relevant software.
How to Apply:
Interested candidates should submit their resume and a cover letter detailing their relevant experience to email protected .
Please include HMO Concurrent Review Coordinator Application in the subject line.
Benefits:
Medical, dental and vision coverage available.
Competitive salaries.
401K with employer contribution.
Generous Paid Time Off.
Weekly/Daily Pay EEO Employer.
Estimated Salary: $20 to $28 per hour based on qualifications.
7 Lake Katrine, NY Lake Katrine, NY Full-time Full-time $25 an hour $25 an hour 4 days ago 4 days ago 4 days ago Northeast Center for Rehabilitation and Brain Injury is a one-of-a-kind state of the art Skilled Nursing Facility located in Lake Katrine 5 minutes off of exit 19 on the New York State Thruway.
Northeast Center offers programs not found in any other nursing home in the region.
We understand the needs of our staff, which is why we have also created a unique benefits program that our staff have praised, which include:
DAILY PAY RAFFLE PRIZES GIVEN WEEKLY/MONTHLY/ANNUALLY FLEXIBLE SCHEDULING GENEROUS PTO INCREASED PAY RATES REFERRAL BONUSES Whether you're starting your nursing career or looking to advance it, Northeast Center for Rehabilitation and Brain Injury is a place to make your mark in the world! As an HMO Concurrent Review Coordinator, you will play a crucial role in ensuring the smooth and efficient coordination of concurrent reviews for patients in our skilled nursing facility.
You will collaborate with healthcare professionals, insurance providers, and internal staff to optimize patient care and financial reimbursement.
Responsibilities:
1.
Conduct Concurrent Reviews:
Perform ongoing reviews of patient records to ensure compliance with HMO guidelines and regulations.
Collaborate with healthcare providers to gather necessary documentation for the review process.
2.
Communication and Coordination:
Interface with insurance companies to facilitate timely concurrent review and request authorization extension for inpatient care services.
Communicate with the insurance company's assigned nurse care manager to provide the most up-to-date level of care and anticipated discharge plan, ensuring the patient is authorized at the appropriate level of care and for the estimated length of stay.
Communicate with internal teams to streamline information flow and address any issues related to concurrent reviews.
Facilitate, review, and submit the requested documentation for Livanta appeals.
3.
Data Management:
Maintain accurate and up-to-date records of concurrent reviews, authorizations, and communications with insurance providers.
Utilize the specific insurance communication systems and other relevant tools to manage, organize, review, and submit related documentation.
Facilitate the delivery of NOMNCs (Notice of Medicare Non-Coverage) and cut letters in a timely matter.
4.
Compliance and Documentation:
Ensure compliance with all relevant CMS regulatory requirements and HMO policies.
Generate reports on concurrent review activities for internal and the billing department.
Requirements:
Bachelor's degree in healthcare administration, nursing, or a related field.
Previous experience in a similar role, preferably in a skilled nursing facility or healthcare setting.
Knowledge of HMO guidelines and regulations.
Strong communication and interpersonal skills.
Proficiency in using EMR systems and other relevant software.
How to Apply:
Interested candidates should submit their resume and a cover letter detailing their relevant experience to email protected .
Please include HMO Concurrent Review Coordinator Application in the subject line.
Benefits:
Medical, dental and vision coverage available.
Competitive salaries.
401K with employer contribution.
Generous Paid Time Off.
Weekly/Daily Pay EEO Employer.
Estimated Salary: $20 to $28 per hour based on qualifications.
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