Tabitha

Continuum Navigator - Insurance Specialist

US-NE-Lincoln
2 weeks ago
ID
2017-5227
Type
Full-Time
Work Hours
8a-5p
Weekend Rotation
on call every 4th or 5th weekend
Hours Per Week
40+
Shift
Day

Overview

Motivated by Christian compassion, Tabitha delivers a continuum of exceptional and innovative Elder Care services that promote the dignity, independence and well-being of older adults.  Tabitha’s love embraces a society where everyone is valued and empowered to live life to the fullest.  Each Tabitha employee upholds the mission and standards of Tabitha.

Responsibilities

POSITION SUMMARY:                                   

The Continuum Navigator  is responsible working directly with elders/residents/clients (hereinafter, “elders/clients”), Tabitha Service lines, referral source and insurance companies including Medicaid and Medicare to assure insurance verifications and prior authorizations is obtained when required and ongoing continued authorizations are maintained.  This position is also responsible for Continuum Navigation functions including the screening and admissions process, care plan management and coordination, and evaluation to ensure elders’/clients’ needs are appropriately met.  The Continuum Navigator embraces all components of the job, fostering an environment that allows Tabitha to provide optimum care to Tabitha’s elders/clients.  This employee strives to uphold Tabitha’s LIVE Culture, Crew Code of Conduct and actively embraces Tabitha’s Core Values.   As a result, the employee supports Tabitha goals related to dignity, respect, independence, competence, autonomy, personal comfort, safety and security of elders/clients.   In addition, the employee contributes to the success of Tabitha through ongoing collaboration with, coworkers, management, volunteers and others in the organization.

 

ESSENTIAL FUNCTIONS:

  • Evaluates client’s medical information to determine Medicare, Medicaid and private insurance reimbursement issues, and acts on issues identified.
  • Provides information to clients/families regarding financial concerns, including general information regarding Medicare, Medicare Part D, and application for Medicaid and other financial assistance programs.
  • Networks and negotiates with community agencies and representatives of insurance companies and/or funding sources. Ability to communicate via phone, fax or electronic portal to insurance company representatives.
  • Completes insurance verifications and documents in appropriate EMR. Obtains prior authorizations when needed.  Communicate authorization and insurance information to clinical staff for ongoing monitoring and case management.  Maintains accurate tracking system of ongoing authorizations to assure timely renewal.
  • Completes insurance assessments per contract and policy and procedure, as assigned.
  • Completes verifications checks in Tabitha systems for Common Working File of Medicare for Secondary Payer information.
  • Is responsible for maintaining all processes for insurance authorization and verification for each insurance company. This position will keep these processes updated as changes with insurance contracts and provider requirements change.  This person will provide these updates to coworkers as a back up to their position.
  • Works with elders/clients, family members, hospital staff, physicians’ clinics, and other referral sources to accept referrals to Tabitha programs.
  • Coordinates the procedures to ensure completion of the admission process and provides follow-up to ensure appropriate services are provided to elders/clients.
  • Works with elders/clients and families to evaluate the elder/client needs including completes elder/client functional assessments, identification of needs and presentation of community resources.
  • Coordinates with the teams of Hospice, and Home Health Care to ensure client services are initiated, and follow through is appropriate for client’s needs.
  • Completes daily management of bed availability for Tabitha’s Living Communities to assure the best possible patient outcomes and meet the Living Communities program goals and budgeted census. Specifically the day to day Admissions to Tabitha Nursing and Rehab Center including the following activities:
    1. Meeting and assisting prospective clientele and their families.
    2. Provides tours and general information related to the facility.
    3. Processes admission paperwork and disseminates information to various departments to ensure successful admission. Updates facility EMR.
    4. Communicates to the Accounting department information regarding insurance and other third party payers to assure client benefits are provided in accordance with Federal and State regulations and facility policy.

Any part of these activities may be assigned to Continuum Navigation for other Tabitha Living Communities based on the need of the Continuum at any time.  Continuum Navigation may serve as back up for those who complete these tasks in other Living Communities or assist with ramp up activities when new Living Communities are opening.

  • Documents and maintains accurate elder/client records related to client referrals, admissions, service planning, and discharges.
  • Accesses, inputs, and extracts information from Tabitha and hospital computer EMR systems and patient medical records in order to monitor and coordinate appropriate health care services for current or referred elders/clients.
  • Provides on call services, including evenings and weekends and ensures 24 hour Continuum Navigation coverage, as assigned.
  • Provides ongoing education and updates to referring agents concerning changes in regulatory guidelines.
  • Develops, monitors, and revises elder/client service needs in conjunction with elder/client/family members and appropriate care providers.
  • Presents to community groups to educate and publicize Tabitha Health Care Services, working with the Speaker’s Bureau and Outreach Department. Creates Marketing packets as needed for Tabitha’s service lines using approved materials from the Marketing Tool Box.
  • Organizes and prioritizes work to complete responsibilities according to plan within established time frames.
  • Performs other duties and special projects as assigned by the supervisor.
  • Acts as a representative of Tabitha at all times, demonstrating professionalism in dress and appearance, courtesy, poise, attitude, interactions.
  • Reports all broken and malfunctioning equipment immediately. Follows disaster plans and uses strength and agility during participation in preparedness drills and actual emergencies.  Maintains a neat and orderly work environment.
  • Completes required training and in-services promptly. Demonstrates understanding of the course content and implements training in daily activities.
  • Considers all factors and takes appropriate action, making good decisions that contribute to the success of the department.
  • Performs work duties within the assigned work environment related to the position, as assigned by Tabitha, regardless of employee preference.
  • Participates in meetings and in-services on both department and company levels.
  • Maintains courteous relationship with supervisors, co-workers, elders/clients, family members, loved ones, members of other departments and volunteers, providing support and assistance to co-workers to ensure quality elder/client care. Volunteers to assist others and seeks opportunities to serve elders/clients/loved ones/coworkers/Tabitha.
  • Maintains a good record of attendance and punctuality as defined by Tabitha’s policy pertaining to attendance and punctuality. Records all time worked accurately and consistently using the timekeeping method provided by Tabitha.
  • Complies with Tabitha policies and procedures as published by Tabitha and which may be modified at Tabitha’s discretion. Contributes to quality assurance and performance improvement activities by identifying instances of non-compliance and taking appropriate action, including reporting violations of Tabitha policy or regulations as appropriate.
  • Acts with integrity and in the best interest of Tabitha. Business relationships are conducted in the best interest of Tabitha, free of gifts, cash inducements, gratuities, favors, or other perceived improper inducements.

 

 

Tabitha’s
TEAM CONDUCT CODE
As a member of the Tabitha team…

 

CHARACTER

            I will always be in character while doing the work of Tabitha.

 

COMPASSION

            I will extend unwavering Christian compassion toward everyone.

 

CONNECTION

            I will build relationships rooted in love, because at Tabitha, love matters.

 

CUSTOMER SERVICE

            I will anticipate each customer’s needs, always looking for ways to exceed their expectations.

 

COLLABORATION

            I will cooperate with others to create an atmosphere of teamwork.

 

COMMUNICATION

            I will accept responsibility for excellent communication and will be constantly aware that what I say and do is a reflection of Tabitha.

 

COMMITMENT

            I will do what I say, when I say, because Tabitha’s success depends on my ability to make and keep commitments.

 

CONTRIBUTION

            I will offer my time, talent, and treasure to Tabitha.

 

COURAGEOUS VISION

            I will support Tabitha’s ongoing efforts to continually improve and am willing to offer ideas and be accepting of change.

 

CONTINUUM

            I will understand who Tabitha is and what Tabitha does in order to support and promote One Tabitha.

Qualifications

COMMUNICATION:  Must be able to speak, read, write, and understand the English language as well as terminology and jargon specific to the job. Sufficient fluency to be able to understand and follow written and verbal instructions, provide instructions to others, read and understand policies, procedures or other similar documentation, interact successfully with elders/clients/caregivers, hold a conversation, conduct or participate in meetings, compose professional e-mails or other written communication, prepare legible, accurate and thorough documentation as required by the job and effectively interact with coworkers, customers, vendors, volunteers, managers and family members.  Ability to recognize and interpret non-verbal cues.  Ability to respond calmly and clearly to emergencies and emotional situations. 

 

WORKSITE CONDITIONS: Works indoors in a facility maintained by Tabitha that will typically be in good repair, clean, well ventilated and well lit.  Work is performed in a standard office setting and in Tabitha Living Communities.  Works in hospital and other care facility environments.  Frequently seated at a desk, working at a computer for extended periods.  Works under daily and hourly deadlines, requiring uninterrupted periods of intense activity.   Adapts to changing work load and work environment.  Traveling is required.  Frequent exposure to interruptions and changes in priorities.  Works beyond normal scheduled hours and on weekends and holidays when assigned.  Is subject to extended hours or callback during emergency conditions or based upon needs of the organization.

 

PHYSICAL REQUIREMENTSAbility to gain access to the work area and then safely perform the duties of the job while utilizing standard and specialized equipment, including but not limited to the equipment described below.  Ability to move about the work area.  Frequent periods of intense activity occasional need for physical strength or physical exertion.  Must have the ability to spot errors or to sense when data output contains an error.  Vision and hearing within normal limits (with or without correction)  Must have unrestricted lift/push/pull ability and pass a 25  - pound physical exam demonstrating strength and agility prior to employment and from time to time thereafter at Tabitha’s discretion.    

 

EQUIPMENT USAGE:   Standard and specialized equipment including laptop, PC, tablet, photocopier, scanner, fax machine, and telephone. 

 

AGE REQUIREMENT:   At least age 18.

 

EDUCATION:           Bachelor’s Degree in human services related field or graduate of an accredited school of social work or college of nursing (RN or LPN) required.

 

EXPERIENCE:          Minimum of four years of experience in the field of gerontology, case management, or public health required.
Medicare and Medicaid training/experience preferred.  Experience and/or training in computerized information systems preferred. 

 

CREDENTIALS:            Valid Nebraska Driver’s license (unless otherwise allowed by law) and a good driving record required.  Must possess auto insurance at or above Nebraska statutory requirements.  Must maintain current licensure or certification, as appropriate. 

STATEMENT OF EQUAL EMPLOYMENT OPPORTUNITY AND AFFIRMATIVE ACTION

Tabitha Health Care Services is an equal employment opportunity employer and does not discriminate in employment on the basis of race, religion, color, national origin, citizenship, creed, gender, sexual orientation, age, veteran status, mental or physical disability, genetic information, or any other characteristic protected by federal, state, or local law.  This policy applies to all employment practices and decisions including recruitment, selection, hiring, training, transfer, promotion, compensation, benefits, and the termination of employment. 

 Furthermore, Tabitha Health Care Services will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship, safety, and/or health risk.  Please contact Tabitha Health Care Services Human Resources Department to request an accommodation.

 As a government contractor, the organization has adopted written Affirmative Action Plans for women and minorities, protected veterans and individuals with disabilities. These plans will be revised on an annual basis. Tabitha Health Care Services is committed to making a good-faith effort toward achieving the objectives of the Plans. Any employee who would like to review the Plans may do so by scheduling an appointment with the Human Resources Department during normal business hours.

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