Critical Path Network
St. Vincent’s Hospital Resource Center Positions
Prompt the care manager to complete an insurance review through a computerized task list. After the care manager has conducted a review for an insurance company, the information electronically comes to the payer specialist, who gets it to the insurance company and negotiates the authorization with the company. The payer specialist then works directly with the care manager to ensure another review is conducted before the patient’s authorized stay expires. For instance, if the insurer approves two days, the payer specialist sets it up so that the care manager is notified to conduct another review within two days.
Makes all the referrals to nursing homes for all patients. The hospital places an average of 280 patients in nursing homes or rehabilitation facilities each month. In the past, the social workers would call the same nursing homes about different patients every day. Under the new arrangement, the placement specialist can call all the nursing homes, find out about available beds, and make more than one referral at a time. The placement specialist works directly with the social workers to anticipate the discharge day and prepare in advance so a nursing home bed will be available on the day of discharge. At first, the hospital required the placement specialist to have a bachelor’s degree in social work. The requirements have changed, and the position has since been filled with someone with experience in office management at a large physician practice.
Denials management specialist.
This employee works closely with the payer specialists to help overturn any denials for payment. In many cases, she already has the documentation at hand and is able to get the payment approved by telephone, without having to file an appeal.
These two employees, who worked in other clerical jobs within the medical center, make all the referrals for home health and durable medical equipment, copy the charts for patients going to skilled nursing facilities, and make all the transportation arrangements for all patients. They fax any patient information that is needed for dialysis center referrals and disability applications.
Handles all incoming calls, greets visitors, and provides secretarial support to the director and manager.