Compliance Support Specialist - Coordination Care

Job Description Why Join TriHealth? Join a team that makes a real impact on patient care. In this role, you'll support our Utilization Management and Care Management teams by ensuring authorizations, documentation, and discharge planning run smoothly. You'll help coordinate communication between payers, care teams, and facilities while keeping critical patient information organized and accurate. If you enjoy meaningful work, staying organized, and helping support seamless patient transitions, this role at TriHealth offers a chance to make a difference every day. Work hours: • Full time, 80 hours biweekly • Day shift • No weekends or holiday commitment Incentives & Benefits: We offer competitive shift differentials, opportunities for professional growth, and a comprehensive benefits package that may include medical, dental, vision, paid time off, retirement savings plans, and tuition reimbursement. For more information, please visit our benefits page: https://careers.trihealth.com/what-we-offer/benefits Job Requirements: • Associate's Degree. Equivalent experience accepted in lieu of degree. • Advanced computer skills, data entry and results reporting, office organizational skills, and medical terminology • Excellent oral and written communication skills • 3-4 years of clerical experience in office, hospital, or care delivery. • Up to 1 year experience in Healthcare either in a hospital or community agency Job Overview: This position provides support and clinical assistance to the Care Management Department. Support includes secretarial and office management and the following specific functions: discharge planning assistance for DME and homecare referrals and contact to ECFs for finalizing plans. This position assists the care management RN's and social workers in assuring that all technical documentation details are met for compliance with MCR and payor guidelines. This position performs secretarial, clerical, receptionist and office management functions. This position receives, organizes and communicates verbal, written information in timely manner. Responsibilities include interaction with multiple systems including payer specific electronic systems, ECIN and Meditech, retrieving approval/certification of days and communicating this to the health plan, care coordinator and billing. The position also includes responsibilities necessary to department statistical reporting and the department quality improvement activities. Job Responsibilities: • Assists with the coordination of discharge plans at the direction of the CC/SW, payer, provider and patient as indicated. Arranges transportation under the direction of the CC/SW. • Attends staff meeting and in-services. Participates in teambuilding exercises as indicated. Engages in educational opportunities to maintain professional competence. • Collects information to identify admissions, discharges, daily patient transfers and cases requiring follow-up by CC or SW. Supports CC/SW by assisting with completion of forms as needed. • Obtains pre-certification or benefit information for homecare, DME, transportation at direction of CC/SW. Responds to payers as directed by CC/SW. Enters/retrieves electronically submitted clinical reviews. • Retrieves admission and discharge reports daily. Manages authorization and denial notifications from payers and inputs information into EMR. • Performs clerical and office management functions for the UM department. Reviews departmental voicemail as outlined in daily workflow. Secures meeting rooms when asked. Navigates required software to communicate with fellow team mates. Keep email open all day for timely communications. Works with other UM CSS team members to perform daily tasks. Working Conditions: Climbing - Rarely Hearing: Conversation - Consistently Hearing: Other Sounds - Frequently Kneeling - Occasionally Lifting 50+ Lbs. - Rarely Lifting <50 Lbs. - Occasionally Pulling - Rarely Pushing - Occasionally Reaching - Rarely Sitting - Consistently Standing - Rarely Stooping - Occasionally Talking - Consistently Use of Hands - Consistently Color Vision - Occasionally Visual Acuity: Far - Frequently Visual Acuity: Near - Consistently Walking - Frequently TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following: Serve: ALWAYS... • Welcome everyone by making eye contact, greeting with a smile, and saying "hello" • Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist • Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS... • Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met • Offer patients and guests priority when waiting (lines, elevators) • Work on improving quality, safety, and service Respect: ALWAYS... • Respect cultural and spiritual differences and honor individual preferences. • Respect everyone's opinion and contribution, regardless of title/role. • Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS... • Value the time of others by striving to be on time, prepared and actively participating. • Pick up trash, ensuring the physical environment is clean and safe. • Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS... • Acknowledge wins and frequently thank team members and others for contributions. • Show courtesy and compassion with customers, team members and the community About Us Careers at TriHealth are diverse. From clinical to administrative, sales to service, our team members contribute skills that are as varied as the services we offer and the people we serve. As an employer, TriHealth demonstrates the organization's values by offering comprehensive benefits packages, competitive wages, and milestone recognition. Explore our career options to help you determine the type of job best for you as well as help narrow your search within our website. 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