Advance Beneficiary Notice (ABN), Auditing, Billing, Certified Case Manager (CCM), Computer Skills, Current Procedural Terminology (CPT), Data Analysis, Healthcare, Healthcare Reimbursement, Hospital, ICD-10, Insurance, International Classification of Diseases (ICD), LCD (Liquid Crystal Display), Leadership, Managed Care, Medicaid, Medical Protocols, Medicare, Patient Admissions, Patient Care, Performance Analysis, Performance Metrics, Spreadsheets, Team Player, Time Management, Word Processing
Department
Post Acute Access
Job Summary
This leader has accountability and oversight, and supervises the daily activities supporting the post-acute admissions team by establishing a collaborative rapport with key stakeholders. This leader is responsible for managing referrals to SMH post-acute services to ensure a smooth transition of care for patients discharging from a care setting to SMH post-acute services. This role is responsible for all elements of access including compliance with all registration, scheduling, regulatory requirements. The Post-Acute Access Manager supports the strategic goals of the post-acute division through timely reporting and analysis of key performance indicators.
Required Qualifications
- Require a Bachelor's degree in related field; Master's preferred.
- Require a minimum of seven (7) years of clinical practice in a hospital or post-acute setting or relevant work experience in lieu of clinical practice (e.g., registration, billing, insurance processing, auditing) with at least two (2) years within a lead or supervisory role.
- Require the following certifications, which may be obtained within one (1) year of hire: - Certified Healthcare Access Manager (CHAM) certification form the National Association of Healthcare Access Management (NAHAM). - Certified Case Manager (CCM) or Accredited Case Manager (ACM), and Admissions Liaison (UDS).
Preferred Qualifications
- Prefer a minimum of five (5) years of experience with Medicare, Medicaid, insurance, managed care, post-acute guidelines, and patient placement in a post-acute setting.
- Prefer knowledge of PPS payment/reimbursement systems.
- Prefer ability to collect, document, and analyze data.
- Prefer experience in computer skills including spreadsheets, database, word processing, and other common applications.
- Prefer demonstrated leadership skills and understanding of group processes, teamwork, and cost center-based management.
- Prefer demonstrated knowledge of International Classification of Diseases Ninth Revision (ICD-10) coding and Current Procedural Terminology (CPT) coding.
- Prefer demonstrated thorough knowledge of Medicare National Coverage Determination (NCD) and Local Coverage Determination (LCD) protocols for medical necessity/ Advanced Beneficiary Notice.
Mandatory Education
Preferred Education
Required License and Certs
Preferred License and Certs
Employment Screening Requirements
As part of Sarasota Memorial Health Care Systems commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/
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Sarasota Memorial Health Care System