Graham Healthcare Group

Receptionist

• Answer telephones/email in a professional manner and direct the caller to the appropriate party.
• Greet and direct visitors to the company.
• Provide callers with information such as company address, directions to the company location, company fax numbers, company website, and other related information.
• Receive, sort, and forward incoming mail.
• Coordinate the pick-up and delivery of mail services (FedEx, UPS, etc.)
• Assist in the ordering, receiving, stocking and distribution of office supplies.
• Maintain appearance of office, ensuring it is tidy, organized and free from safety hazards.
• Assist with clerical duties such as photocopying, faxing, filing and collating.
• Maintain Telehealth equipment: Log all incoming and outgoing equipment, clean and test equipment, mail equipment to patients/staff.
• Assist with bulk mailing projects: merge Excel spreadsheet files for labels, envelopes or documents.
• Coordinate monthly ordering of office supplies.
• Coordinate communications to vendors for facility requests.
• Order coffee refills/supplies.
• Support requests for access to Supply Room.

Hospice Receptionist

General

• Provide supervision and direction for field staff and act as a liaison between field and office staff.
• Monitor clinicians via HCHB reports
• Update Clinical Record on an ongoing basis as relates to communications, orders, re-hospitalizations, conflicts, etc.
• Evaluate and address customer concerns, including documentation and resolution.
• Communicate with sales personnel regarding customer issues that arise and may affect referral source relationships.
• Responsible for communication with clinicians and physicians when adult protective services referral required.
• Evaluate client episode to determine appropriateness of discharges versus recertification and initiation of orders as appropriate.
• Review and manage visit time exception requests.
• Review staff schedules to assure productivity, communicating with PSC of staff availability as well as proving Clinical Manger with projected productivity for staff once/week. Obtains physician orders for field staff from physicians, laboratory results and resumption of care orders as needed.
• Responsible for direct management of the POD’s Clinical Field Staff, assigning tasks and objectives and establishing clear measurables for monitoring results versus objectives.
• Responsible for the development and engagement of POD’s Clinical Field Staff by fostering a motivating work environment that recognizes and reward strong performance.
• Review and Approve Orders, Evaluation Documentation and frequency of visits.
• Reviews potential LUPA cases with ACD
• Participates in staff meeting and in-services.
• Distributes monthly staff meeting information to staff not attending.
• Case conference with assigned field staff as required.
• Perform annual performance evaluations on field staff.
• Works with clinicians in developing the patient frequency of visits that are clinically appropriate.
• Assists agency personnel in care coordination of patient/client services. Serves as a liaison between the organization, referral sources and patient/clients.
• Assist in education of staff regarding hospitalizations
• Proficient in HCHB and Outlook
• Maintains Medicare guidelines regarding consents, ABN, non-provider coverage forms.
• Participates in ongoing education.

Clinical Field Staff Supervisor

Consultant

• Maintain relationships with all existing referral sources
• Actively prospect for new referral sources based on the Agency’s scope of service
• Establish and maintain positive working relationships with current and potential referral and payer sources and field staff
• Work closely with Marketing, Agency Administrator, and Clinical Management to ensure that the demand for clinical care is aligned with our capacity and at no time compromises the Agency’s ability to provide the best quality care for our patients

Hospice Consultant

Vice President

• Responsible for organization, leadership and provision of agency clinical programs and daily operations
• Responsible for review, analysis, and appraisal of the effectiveness of the total Agency clinical program and daily operation
• Directs team members in improving clinical outcomes, operational processes, and quality improvement activities.
• Develops and prepares reports to inform President and Board members of team initiatives, project status, issues, results, achievements, and quality improvement activities

Vice President – Home Health

Insurance

• Ensure that benefit information, authorization, and patient liability are obtained prior to clinical staff starting care for any service lines and branches
• Work closely with other departments to ensure that correct funding source information is updated in a timely manner
• Obtain detailed and accurate benefit information using payer portals, phone, or fax for all insurance companies accepted by Home Health product lines
• Validate and document all payor information such as patient name, DOB, and policy number in the EMR
• Reduce write-offs by clearly documenting benefit information such as deductibles, co pays, co-insurance, and out-of-pocket maximums in the patients’ charts through coordination notes
• Continuously monitor task flow screen related to all insurance issues including but not limited to the following: verify Medicare eligibility, follow up to on-call completed insurance, complete insurance verification, review eligibility alerts, obtain initial authorization, re-verify insurance at recertification, and resumption of care
• Review of entitlement verification reports daily, researching any questionable answers
• Review problems related to all insurance changes daily
• Review of issues related to funding source updates daily
• Reverify current Medicaid patients to monitor HMO status monthly
• Reverify current patients’ insurances monthly to monitor for any payer changes or other agencies monthly
• Contact patients, hospitals, or physician offices for information or to clarify benefit
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Reduce write-offs by working with the clinical staff to ensure transfer of agency/provider of choice forms are received and sent to the other agency within the appropriate timeframes
• Obtain detailed and accurate authorization, prior authorization, and ongoing authorization as required by insurance companies accepted by the company via phone, fax, or payer portal
• Understand and maintain the authorization tab in HCHB
• Provide clinical information as requested by insurance companies
• Contact insurance companies as needed to review authorization submissions and requests for more clinical information and notify internal clinical staff of authorization approvals and denials
• Continuously monitor task flow screen related to all authorization issues including, but not limited to the following: determine if reauthorization needed for new orders, follow up on on-call completed authorizations, obtain initial authorization, obtain reauthorization, and update pending authorization with actual authorization information
• Assist scheduling with funding source problems related to scheduling out visits to clinical staff
• Assist billing department insurance verification discrepancies or authorization discrepancies which could hold up claim submission
• Establish a thorough knowledge of all payer portals
• Comply with the company’s Core Values and Core Competencies

Insurance and Authorization Coordinator

• Ensure that benefit information, authorization, and patient liability are obtained prior to clinical staff starting care
• Work closely with other departments to ensure updates in funding source information
• Obtain detailed and accurate benefit information using payer portals, phone, or fax for all insurance companies
• Validate and document all payor information in the EMR
• Reduce write-offs by documenting benefit information in patient charts
• Continuously monitor task flow screen related to all insurance issues
• Review entitlement verification reports daily, researching any questionable answers
• Reverify current Medicaid patients to monitor HMO status monthly
• Contact patients, hospitals, or physician offices for information or to clarify benefit
• Assist billing department with insurance verification discrepancies

Hospice Receptionist

Clinical Field Staff Supervisor

Hospice Consultant

Vice President – Home Health

Insurance and Authorization Coordinator

Insurance & Authorization Coordinator