CCS Coordinator (Case Management, Pediatric) *Hybrid*
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 day-today activities
- Organize, track, and distribute incoming faxes/medical records
- Create authorization/tracking numbers for inpatient and post-acute encounters
- Obtain in-patient reviews and follow-up 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 out-of-network admissions & requests
- Request complete medical records from out-of-network facilities for medical review
- Monitor OB/CCS encounters as assigned
- Work with the provider/Hospital to obtain required information to submit to CCS
- Submit required CCS application, release authorization while pending SAR
- 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 follow-up 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, ICD-9/10 codes
- Proficient with Microsoft applications and programs such as EZCAP, EZCARE
- 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:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
Environmental Job Requirements and Working Conditions:
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754.
- The total compensation target pay range for this role is: $18.00 - $23.00 per hour. The salary range represents our national target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
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