With 100+ physicians in 20 specialties, Collom & Carney Clinic serves the healthcare needs of more than 200,000 active patients. This "Physician Owned" group has been a staple in East Texas for the past 70 years. Medical Group Management Association (MGMA) has recognized Collom & Carney as a better performer in the "Performance and Practices of Successful Medical Groups." The clinic has received this distinction since 1998, the first year criteria was developed for this award. The clinic has always maintained a standard of professionalism and excellence, yet within a friendly working environment. All of our physicians are provided with the best resources available, including state-of-the-art equipment, superior staff support, and administrative assistance.
Strategically manage services for specified patient population. Provide a focus on wellness, prevention, and efficient care through the coordination with patients, their families, and physicians. The education of the patient and his/her family will be incorporated into the care plan after careful assessment of the patient’s knowledge base, home life, and post-acute resources. The Case Manager will play a vital role in the clinical, financial and education of patients and will ensure these aspects are all considered simultaneously throughout the continuum of care. The Case Manager will ensure the patient receives the right services at the right level of care and will assist the patient in navigating their own care at an optimum level.
1. The ability to demonstrate knowledge and effectiveness of Case Management principles in the following health care areas; processes, relationships, management, community resources, service delivery, psychosocial interventions and all other areas of Case Management.
2. Design and develop a process of identifying patients in need of ongoing surveillance, tracking and screening for development of further complication and follow-up in partnership with the health care team.
3. Coordinates with patient, families, and health care teams to develop a mutually agreeable plan of care that meets the needs of the individual patient.
4. Research the healthcare environment for innovative concepts and best practices and develops practical applications for quality improvement.
5. Develop and maintain processed to improve transitions of care, focusing on hospital and ED discharges as well as post acute care facility usage and interactions with specialists.
6. Develop and maintain processes measuring the patient experience, clinical quality measures and utilization management that drive the cost of care.
7. Keep patients well informed by telephone and in writing of activities/case summaries.
8. Demonstrate sensitivity to issues and show pro-active behavior in addressing client and patient needs.
9. Promotes health education and provides literature to patients to enhance understanding of a condition, treatment or procedure.
10. Assist patients in addressing questions to their physician.
11. Coordinate services for the patient population having a health risk or chronic condition to include screening and on-going monitoring.
12. Utilize appropriate community health care resources to maximize patients healthcare outcomes.
13. Maintain confidentiality and adhere to HIPAA requirements.
14. Document clinical information completely, accurately and in a timely manner.
15. Other duties as assigned.
1. Current LVN/LPN or RN license.
2. Experience with Medicare population a strong plus.
3. Must possess a working knowledge of CPT/ICD-10 codes.
4. Two – three years experience of utilization or Case Management preferred.
5. Knowledge of managed care principles regarding legal and regulatory requirements and confidentiality preferred.
6. Must have excellent communications and presentations skills.
7. Demonstrates diplomacy and professionalism when dealing with staff or patients.
8. Knowledge of primary care a plus
1. To work one on one with the patient if for any reason the patient is not aware of a balance on account.
2. Key collection reports when needed.
3. Key batches and blue mail when needed.
4. Step in for Supervisor when she is out of office.
5. Verify benefits on various procedures and treatments.
6. Calls patients with benefits.
1. Pleasant, friendly disposition with the ability to work well with patients.
2. Awareness of need for discretion and for keeping confidential all matters relating to
clinic, employees and the patients.
3. Intelligence to use judgement and initiative determining the course of action with
patient accounts.
4. Ability to handle stressful situations while remaining calm and helpful.
5. Tact and diplomacy when dealing with patients.
6. Representing clinic in professional, courteous manner.
7. Able to accept new ideas and implement change in department.
Taking care of all accounts with Blue Cross Blue Shield as their primary insurance.
1. File all Texas and Arkansas Blue Cross Plans Claims. This involves making sure all correct information is printed on the claims before mailing them.
2. Works all above insurance denials. Must decide why a claim was denied, correct it if possible and re-file as soon as possible.
3. If a procedure is denied that we cannot collect on, maybe the procedure is bundled or global, then you must write up a request for a write off to forward to Data Department.
4. Answer phone calls from the patients or other departments.
5. File all supplement insurance claims, which involves matching the claims with the Blue Cross EOB’s and mailing them.
6. Order claims form EOB’s that don’t have a matched claim and vice versa.
1. High school graduate or equivalent.
2. Computer experience.
3. Must know how to use a CPT book and ICD-10 book. At least 2 - 4 weeks of training is required.
4. At least one year follow-up experience on claims is desirable.
QUALIFICATIONS
1. Pleasant, friendly disposition with the ability to work with patients as well as employees.
2. Awareness of need for discretion and for keeping confidential all matters relating to clinic, the employees and the patients.
3. Intelligence to use judgement and initiative in determining the course of action with filing claims.
4. Ability to handle stressful situations while remaining calm.
5. Exhibits a cooperative helpful manner toward co-workers.
6. Tact and diplomacy when dealing with patients.
Perform audits as requested for the compliance process improvement, coding validation and other processes that affect reimbursement. Responsibilities also include recommending edits of CPT/ICD-10 codes and descriptions to conform to billing rules and compliance standards, and assist in insuring reimbursement integrity. Maintain a working knowledge of Medicare/Medicaid/Third Party Payers payments regulations and mechanisms for payment while serving as a resource for facility staff for compliance/coding questions.
Must have an understanding of federally funded payer reimbursement regulations. Ability to work independently on multiple, complicated tasks with little or no intervention. Excellent oral and written communication skills. Must have ICD and CPT code knowledge, computer literacy and chart/bill audit experience preferred. Demonstrate ability to maintain strict confidentiality.
Must be a graduate of accredited School of Nursing or credentialed healthcare professional.
Responsible for taking care of the building's cleanliness. Provide a clean and sanitary environment for our patients, employees and guest.
High School Diploma or equivalent.
Strategically manage services for specified patient population. Provide a focus on wellness, prevention, and efficient care through the coordination with patients, their families, and physicians. The education of the patient and his/her family will be incorporated into the care plan after careful assessment of the patient’s knowledge base, home life, and post-acute resources. The Case Manager will play a vital role in the clinical, financial and education of patients and will ensure these aspects are all considered simultaneously throughout the continuum of care. The Case Manager will ensure the patient receives the right services at the right level of care and will assist the patient in navigating their own care at an optimum level.
1. The ability to demonstrate knowledge and effectiveness of Case Management principles in the following health care areas; processes, relationships, management, community resources, service delivery, psychosocial interventions and all other areas of Case Management.
2. Establish collaborative working relationships with patients, providers and resources.
3. Communicating with and obtaining the approval of the patient and or the parent to arrange appropriate care.
4. Keep patients well informed by telephone and in writing of activities/case summaries.
5. Demonstrate sensitivity to issues and show pro-active behavior in addressing client and patient needs.
6. Promotes health education and provides literature to patients to enhance understanding of a condition, treatment or procedure.
7. Assist patients in addressing questions to their physician
8. Follow and monitor patient outcomes
9. Utilize appropriate community health care resources to maximize patients healthcare outcomes.
10. Maintain confidentiality and adheres to HIPAA requirements
11. Document clinical information completely, accurately and in a timely manner
12. Other duties as assigned.
1. Current LVN/LPN or RN license.
2. Experience with Medicaid population a strong plus.
3. Must possess knowledge of CPT/ICD-9/10 codes.
4. Two – three years experience of utilization or Case Management preferred.
5. Knowledge of managed care principles regarding legal and regulatory requirements and confidentiality preferred.
6. Must have excellent communications and presentations skills.
7. Demonstrates diplomacy and professionalism when dealing with staff or patients.
Must have current LPN/LVN License.
Must have current license.
Will be required to work occasionally work night clinic.
