Ccs Coordinator - Monterey Park, United States - Astrana Health

Astrana Health

Verified Company

Monterey Park, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Job Title:
CCS Coordinator

Department:
Health Services - ICM

About the Role:

The CCS Coordinator will assist the inpatient case management department in assigned areas of responsibility, including creation of authorizations/cases, tracking/maintaining records, conducting phone and fax communication, and sending/generating authorizations and denial letters.

The CCS Coordinator must be proficient in all CM processes and must support member management whole adhering to health plan Division of Financial Responsibilities and plan contracts.

The CCS Coordinator will ensure that all authorizations/cases are processed according to policies and meet all health plan, federal, and state requirements.

What You'll Do:

Comply with department policies and procedures
Participate in periodic performance reviews/audits
Provide support to case managers and colleagues on daytoday activities
Organize, track, and distribute incoming faxes/medical records
Create authorization/tracking numbers for inpatient and postacute encounters
Obtain inpatient reviews and followup discharge dates & arrangements as assigned
Communicate with hospitals, SNF, rehab, and health plan on authorizations and member status (tracking, pending, denied, complex case)
Provide authorization(s) for services requested on discharge (i.e., DME, Home Health, others)
Update authorization notes to include the status of tracking number and efforts towards member management (approved, denied, or pending)
Notify Case Managers of admission & authorization status
Notify Case Managers of outofnetwork admissions & requests
Request complete medical records from outofnetwork facilities for medical review
Monitor OB/CCS encounters as assigned
Work with the provider/Hospital to obtain required information to submit to CCS
Create a CCS case when member has been approved by CCS for tracking
Assist in identifying areas of improvement that occur within the department
Responsible for followup and returning department calls
File and scan hospital records as assigned
Respond to inquiries in a timely fashion; directing to clinical staff as needed
Report to supervisor, manager, and/or medical director on activities or problems occurring throughout the day
Attend to provider and interdepartmental calls in accordance with exceptional customer service
Ability to keep high level of confidence and discretion when dealing with sensitive matters relating to providers and members

Qualifications:

High School Graduate or equivalent
A minimum of 2 year experienced in managed care environment to include but not limited to an IPA or MSO preferred.
Knowledge of medical terminology, RVS, CPT, HPCS, ICD9/10 codes
Good organizational skills
Good verbal and written communication skills
Must have the ability to multitask and problem solve in a fast pace work environment
Personal & Professional Qualities
Punctuality, attention to detail, creativity, etc.
Ability to follow directions and perform work independently according to the department standards
Able to function effectively under time constraint
Able to maintain confidentiality at all times
Willingness to accept responsibility and desire to learn new tasks
Ability to comply and follow NMM company policies and procedures
Must be a strong team player, punctual and have excellent attendance record

Who We Are:

Astrana Health (

NASDAQ:
ASTH) is a physician-centric, technology-powered healthcare management company.

We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner.

Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for over 1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Our Values: