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Insurance & Claims

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As a member of our Claims Connect team, you'll help process and deliver the claims information Kaiser Permanente's members, providers, regulators, and customers need, and expect, from a world-class health care organization.

Coordinator Home Health and Hospice Referrals (Per Diem) Capitol Hill / Seattle

Location: Seattle, WA Additional Locations:
Job Number: 788525 Date posted: 04/23/2019
Description:
Receives, processes, and coordinates the time sensitive referrals to home health and hospice services according to the services required, coverage criteria and Medicare regulations. Knowledge of health plan functions include interpreting coverage as well as Medicare regulations for home health and hospice referrals. This process involves over 4,000 referrals to Home Health per year and 1600 referrals to Hospice. Requests authorization for Options enrollees referred to Kaiser Foundation Health Plan of Washington Home Health or Hospice services. Ability to work in multiple software applications in order to verify clinical, benefit, and demographic information necessary to process referrals.


Essential Responsibilities:

  • Receives referral requests for Home Health, Palliative Care, and Hospice services. Checks coverage/benefits on each referral.  Coordinates referral requests with internal KFHPW and external HH agencies according to benefit eligibility and Medicare regulations.  Coordinates priority of visit from Home Health or Hospice providers with referral RNs and branch Resorce Nurses to ensure patients receive care needed.  Places referrals with outside HH / HP agencies, communicates cares needs and urgency of referral,  and documents disposition of the referral in medical record.

  • Manages high volumes of communication by acting as a liaison for physicians, patients, interdisciplinary teams and Home Health and Hospice staff. Assists with transition management by notifying clinical staff of acute care admits/discharges.

  • Collects data for reports. Runs quality checks to ensure referrals have been processed according to standards. Creates and distributes reports for coordination of patient's care across home health and hospice. Maintains department process and manuals necessary to ensure coordination of care.

  • Loads Home Health and Hospice electronic medical record (EMR) with demographic and other clinical information necessary to include current medication for clinical field staff and other KFHPW providers to ensure coordination of care

  • Basic Qualifications:

    Experience

  • N/A

  • Education

  • High School Diploma/GED.

  • License, Certification, Registration

  • N/A



  • Additional Requirements:

  • Communication skills.

  • Computer skills.



  • Preferred Qualifications:

  • Basic knowledge of medical terminology

  • Primary Location: Washington,Seattle,Capitol Hill Main Building 201 16th Ave. E Scheduled Weekly Hours: 1 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 8:00AM Working Hours End: 5:00PM Job Schedule: Per Diem Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Individual Contributor Job Category: Insurance / Claims Department: Home Health and Hospice Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Insurance & Claims Careers

    Careers in Insurance & Claims

    Our insurance and claims teams are committed to meeting customer and member expectations when it comes to the timely and accurate processing of claims, while remaining in compliance with federal, state, and local laws, as well as regulations and rules. Make an impact as you contribute to the implementation of contemporary technology in areas such as claims quality, claims operations, business analysis, processing, configuration, reporting, and more.

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