Intake Nursing Supervisor
Reports to: Director of Professional Services
Receives, evaluates, and coordinates referral activity.
Verifies third-party reimbursement coverage.
Follows up on pending unresolved coverage issues.
Distributes information to appropriate division for scheduling of employees.
RN/LPN with current license to practice in state(s) of operation.
Minimum of one (1) year nursing experience, with at least one year home care experience preferred.
Knowledge of community resources, Medicare and state regulations, ACHC requirements, and reimbursement criteria for third party and private payers.
Excellent communication skills (verbal and written), interpersonal skills, and documentation skills.
Demonstrated organizational and time management skills, critical thinking, and ability to work independently.
Computer data entry skills.
Essential Functions/Areas of Accountability
1. Receives and processes all requests for services.
a. Completes referral form with medical and demographic information.
b. Distributes referrals for assignment, scheduling, and billing.
c. Disseminates information and answers inquiries related to the availability of resources.
d. Assists in establishing the initial Plan of Care and arranges for supplies and equipment for the client.
2. Establishes system for prior authorization from third-party payers.
a. Maintains logs and files necessary to assure compliance.
b. Develops and implements procedures for completing and filing reimbursement forms.
c. Reviews all communication from insurance companies/other payers.
d. Communicates with families and clients regarding the coverage for home care services.
e. Acts as an educational resource to physicians, social workers, discharge planners, and utilization review staff regarding home health services and available coverage.
3. Collaborates with Marketing Staff in providing education and resources to Agency staff
a. Educates clinical and accounting staff about insurance benefits and coverage criteria.
b. Works with community referral sources, families, and Agency staffs to problem solve and identify services available to the client either through Agency services or the community.
c. Participates in Agency orientation for new staff in matters pertinent to client admission criteria.
d. Provides outside facilities, if indicated, with information about availability and type of services and reimbursement.
e. Follows up on client transition to home. Communicates with referral sources.
4. Demonstrates teamwork and effective communication to accomplish Agency and client goals.
a. Participates in care conferences and other team/Agency meetings.
b. Shares client observations and pertinent information regarding reimbursement.
c. Initiates interdisciplinary referrals and works with teams to identify and access outside resources as appropriate.
d. Participates in Agency quality improvement activities. Initiates activities related to improvement activities in admission/intake area.
5. Performs job in compliance with Agency policies and procedures and professional and community standards.
a. Accepts responsibility in accordance with the role of Intake/Referral Nurse.
6. Provides services in accordance with state and federal laws, and ACHC standards..
a. Accepts responsibility for personal and professional development and identified learning/developmental needs.
b. Maintains confidentiality in all aspects of the job.
7. Performs other duties and activities as deemed necessary.Company Description
One Home Health-IL is a privately owned Home Health Agency. We take great pride in the family atmosphere that has been created with our agency. Our nurses, therapists, and aides are given tremendous support by a hands on Director of Nursing and wonderful team of office and field staff!