Graham Healthcare Group

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

Insurance & Authorization Coordinator

Administrative Assistant

• Coordinate, schedule, and assign palliative patients to providers
• Conduct follow-up calls to patients and families to collect data about patients/family response to the treatment plan established by the assigned provider
• Serve as the contact point, advocate, and informational resource for patients, care team, family/caregiver(s), payers, and community resources
• Manage referrals, when needed, to appropriate agencies required to assist the client in achieving the goals and objectives identified in their Care Plan
• Assist patients in problem-solving potential issues related to the health care system, as well as financial or social barriers (e.g., request interpreters, transportation services, or prescription assistance as appropriate)

Palliative Administrative Specialist

Business Development Rep

• Define and maintain the criteria for attractive geographies
• Develop and refresh a data-driven view of priority markets
• Regularly update and rank high-priority geographies
• Engage executive leadership to ensure alignment
• Develop and maintain a proprietary pipeline
• Translate strategy into actionable target lists
• Spend time in-market refining target lists; complement with desktop research, market and competitive intelligence, and operator input
• Field inbound opportunities and facilitate rapid “go/no go” decision making relative to GHG’s strategy and priorities
• Engage high-potential companies directly, where appropriate
• Build long-term relationships with brokers and bankers
• Lead deal structuring and LOI development (with final approval by CEO, CFO)
• Orchestrate diligence across functions, third parties

Director of Business Development – Mergers & Acquisitions

Auditor

• The Internal Controls Specialist will be responsible for the execution and support of Graham Healthcare Group’s (GHG) quarterly and annual SOX compliance program.
• Maintenance of quarterly and annual SOX/Graham requirements in accordance with established schedules and deadlines
• Assist with annual SOX testing requirements, which include testing of existing and newly implemented controls
• Create accurate and detailed audit work papers clearly describing the work performed, results of testing, and conclusions reached
• Perform weekly and quarterly monitoring’s
• Assist in the definition of remediation plans, activities and retesting for potential issues and process improvement opportunities.
• Maintain current knowledge regarding changes to SOX compliance regulations and ensure that GHG adjusts methodologies in response to the changes by drafting guidance and instructions to the appropriate stakeholders and personnel.
• Assist with various ITGC compliance requirements which could include:​
• Assist in the performance of semi-annual User Responsibility Matrix reviews for core systems
• Reviewing audit logs and implementing corrective actions where needed
• Maintenance of internal control documentation (policies, procedures, narratives, test plans, etc.)
• Assist in completion of annual assessments related to systems including disaster recovery and sensitive data evaluations
• Determine and recommend improvements to current risk management controls as needed.
• Assist management with updates to the control environment to align with system implementations and system changes ensuring alignment with identified risks
• Ability to travel no more than 10% of the time

Vice President – Home Health

Insurance and Authorization Coordinator

Insurance & Authorization Coordinator

Palliative Administrative Specialist

Director of Business Development – Mergers & Acquisitions

Internal Auditor