Social Worker - Fairfax, United States - Fair Oaks Health & Rehabilitation

Description

• Maintains primary focus of census development and revenue enhancement
• Provides documentation of contract or payor information on a timely basis to treatment team and business office billing staff, following case management policies
• Monitors that records pulled for insurance provider requests are complete and appropriate
• Monitors census and profitability of managed care residents.
• Assists accounts receivable bookkeeper to assure accurate billing and timely collections by adhering to case management procedures. Assists with the appeal process when appropriate and upon request.
• Maintains all operational documentation as indicated by Corporate and Center management
• Participates in developing and updating case management policies and procedures, and maintains required records and reports
• Coordinates work between departments; Maintains confidentiality of necessary information
• Participation in joint operating committee meetings with MCO's
• Obtains preauthorizations for ancillary services if required.
• Participates in discussion of the case management resident's status towards the goal to the next level of care with IDT team
• Provide concurrent review to MCO case manager as required.
• Provides accurate and timely documentation and summaries if required by MCO (in addition to copies of the medical record).
• Provide coverage for other case manager's time off as requested.
• Meets with resident and/or family to discuss insurance coverage or benefits
• Participates in weekly case management conference call
• Participates in quarterly case management meetings as indicated
• Responsible for education and training of interdisciplinary team regarding contract rates and terms
• Participates in external contract orientations
• Conducts outside sales calls and CE presentations as required and as directed by their supervisor
• Serve as a consultant on managed care collections
• Performs any miscellaneous work assignments as may be required

• Negotiates appropriate level of care within contract terms with the payor case manager; Utilizes "Out of Contract Pricing Worksheet" for noncontracted arrangements
• Communicates information to care team and coordinates resident's smooth transition to the next level of care.
• Obtains accurate information from physicians, resident, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team
• Develops referrals from hospitals' social service and discharge planning departments, physicians, case managers, insurance companies and other referral sources
• Visits hospital social workers, physicians, hospital discharge planners and administrators, attorneys, support organizations (i.e., oncology, stroke, head injury, etc.), civic/professional organizations, etc. to understand the need for program services and to communicate services offered which meet these needs to obtain referrals of residents
• Invites referral sources to nursing center and presents programs and presentations to support groups, insurance companies, self insured industry, physicians, etc.; Networks through case management organizations by attending community meetings regularly.
• Acts as a liaison between payors and decision makers facilitating a smooth transfer of information
• Assists in program evaluation as requested.

• Associate degree in the health & human service field required
• Current, active, and unrestricted licensure or certification in a health or human services discipline preferred.

• Minimum two (2) years' experience in medial case management. Comprehensive knowledge of workers' compensation, insurance, and managed care, required. Ability to negotiate coverage and provide complete and timely case mgmt reports, required. Prior experience with an insurance company, private case mgmt. Company, or HMO, preferred. Familiarity with long

• Work is primarily sedentary in nature, with exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull or otherwise move objects, including the human body. Involves sitting, standing, and walking most of the time; also requires driving.

• Travel is required between two buildings in Fairfax and Arlington, VA

• Work closely with Administrators, Department Heads, Families, Residents, Physicians, Discharge Planners/Social Workers, Insurance Case Managers, and selfinsured employers.

• Must be able to execute the terms and conditions set forth in the Employee Handbook, including, but n