ADMISSIONS & UTILIZATION REVIEW COORDINATOR FOR OUTPATIENT FACILITY Position Available In East Baton Rouge, Louisiana

ADMISSIONS & UTILIZATION REVIEW COORDINATOR FOR OUTPATIENT FACILITY 3.5 3.5

out of 5 stars Baton Rouge, LA 70816 To review patient referral packets received from Hospitals, Community and other agencies through Outlook Email, fax and Marketing personnel. Review eligibility criteria for admission to Apollo Behavioral Health Hospital Outpatient services. Process the referral through the admissions process to convert the referral to admit efficiently. Schedule the admissions and doctor office visits for clinic patients. Get Prior Authorizations, Concurrent Authorizations and Retro authorizations from insurances for the services provided at apollo. Maintain the referral and admission logs. Generate Monthly stats and report to

QAPI. ESSENTIAL JOB FUNCTIONS

Review eligibility criteria for admission to Apollo Behavioral Health Hospital. Get Prior Authorizations, Concurrent Authorizations and Retro authorizations from insurances for the services provided at apollo.

ESSENTIAL JOB FUNCTIONS AND DUTIES

include but are not limited to the following: Responsible for intakes and completing inquiry forms. Reviews packets for criteria and updates intake logs. Conduct Utilization Review Collects data for QAPI on intake. Reviews intake on tablet when away from desk. Communicates with physicians, Program Director and Nurse about possible admissions. Initiates demographics on face sheets, episodes of care and insurance information in ICanotes (EHR) for new admits and put new patient charts together. Completes insurance verifications as patients accepted by physician. Assists by answering phones, taking messages, filing, etc. Helps maintain activity flow on patient board. Communicates current health status and needs of patients to appropriate health professionals. Stays abreast of Federal, State, and local laws and regulations complying with infection control and employee health standards. Advises Director of Nursing/Administrator of any risk management activities in order to reduce or eliminate patient/staff/visitor injuries, illnesses, death, and/or financial loss. CLINIC Schedule patients to see MD/NP in the clinic. Collect Co-pays and deductibles from patients. Get Insurance auth for MD/NP visit. Create a chart for the patient in the EHR (ICANotes) with demographics and Insurance information and any home meds list. Print the schedule rooster for the MD/NP rounds. Collect the billing sheet from MD/NP after rounds, file it and send it to billing team. Daily close the accounts after MD/NP rounds and account for the cash collected. Take messages from patients and pass them to the MD/NP. Maintain Clinic Schedule.

CLERICAL DUTIES – GENERAL

Maintains a log of census reports. Completes census report daily. E-mail daily reports to the appropriate management staff Complete the discharge report at the end of the month and email to the appropriate management staff. Posts payments and applicable credits to accounts while maintaining balance sheets.

UTILIZATION REVIEW

Assists in the implementation of the hospital wide-UR programs. Using established utilization review standards, reviews adult psychiatric services patient records to ascertain compliance with medical eligibility criteria. Based on patient diagnosis and other established criteria, performs continued stay reviews as indicated. Conducts authorization/certification reviews and submits requests to commercial insurance companies or Medicaid for inpatient mental health authorization. Performs concurrent reviews to receive approval of medically necessary treatments or services to ensure that patient is getting the right care in a timely and cost-effective way. Collects and compiles statistical and other data regarding reviews. Monitors and collects results of physician advisor reviews for inclusion in patient charts Monitors and collects results of physician advisor reviews for inclusion in patient charts. Adhere to DHH and

ABHH LLC

rules police and procedures. Complies with rules and regulations as indicated by time and attendance records and substantial procedure/rule violations. Assume additional responsibilities as necessary for the smooth and efficient operation of unit/office.