Amanda Jansen

• Delivers a differentiated and seamless referring partner, patient, and agency experience by developing and leading a service-minded culture and consistency in daily operations
• Communicates directly with all involved including but not limited to the attending physician, referring physician, nurse, facility, patient, and families
• Obtains demographics and clinical information from clients, physicians office and other referral sources to compile referrals
• Maintains integrity of referral network, physician relationships and departmental support alongside operations and growth and support partners
• Conducts daily meetings with Executive director, Clinical director, Account Executives, clinical staff, and schedulers to assure patients are seen, scheduled, and discuss the sensitivity of daily patient medical needs to assure appropriate skills are addressed and correct clinicians are assigned
• Effectively triages incoming calls and messages from referral sources and other partners
• Interpretation of physician orders
• Obtains ICD 10 appropriate coding for appropriate diagnoses indicated on medical charts/physician orders
• Provides general information about agency services to patients, families and other referral partners as needed
• Maintain compliance by documenting accurately and timely with the organizations electronic medical record
• Assist in data entry and tracking of non-admitted patients
• Serves a patient advocate ensuring optimal patient outcomes
• Fills in for location Management as needed
• Maintains compliance in all internal, external electronic systems
• Complies with all state and federal referral/intake regulatory requirements
• Responsible for timely response to referrals in electronic referral portals

• Responsible for day-to-day staffing, problem solving, leading in the hiring process, providing orientation to new caregivers, payroll/billing, and ensuring customer satisfaction
• Coordinates and ensures the scheduling of client cases on a daily basis
• This includes selecting the appropriate caregiver, communicating with the family or client on an ongoing basis regarding staffing
• Manage inquiry calls from clients, client families, and caregivers
• Performs family consultation visits as assigned
• Participates in the orientation of new caregivers
• Provides education on benefits, leaves of absences, payroll, HR policies, and updated policies/ procedures to new hires, employees, and executive director
• Backing up in Processes of payroll for caregivers on a weekly basis
• Ensures computer data is updated and accurate for client schedules and employee availability
• Anticipates staffing needs and works with the Executive Director to ensure that an adequate pool of employees is maintained
• Ensures that all client's requested services hours are staffed with appropriate personnel
• Follows all policies and procedures and state/funded programs as appropriate
• Continually monitors customer satisfaction and informs the Executive Director and/or Business Manager of any issues related to customer satisfaction
• Keeps the Executive Director informed of any employee/client incidents and works with the Executive
• Director to bring resolution to any identified problems
• Ensures on-site supervisory visits are conducted per policy
• Informs the Executive Director of any overtime requested or worked by caregivers
• Ensures that pay rates are within the acceptable ranges
• Responsible for approving, coordinating, entering, and auditing payroll/billing on a weekly basis and ensuring the entry is timely and accurate
• Participates in the orientation process for all staff
• Ensures that all employees are provided appropriate orientation to assignments or job
• Assists in the process of maintaining employee personnel files
• Performs data entry of new clients and employees as needed
• Compiles and maintains client files
• Conducts interviews, managing the candidate pool, placing candidate in jobs, background checks, schedules fingerprints, verifying credentials, and follows new applicant through processing the onboarding process, including to completion
• Ensures the employees remained in compliance with all state required training, regulations, and mandatory annual trainings.

• Financing, maintaining over 700 accounts, Interviewing and training of 27 offices, adhering to financial guidelines and applications, responsible for the files and needs of over 700 accounts, medical record retrieval, responsible for all monies coming in and out of the establishment, processing finance applications for credit approvals and following through with approval contracts and negotiations, adhering to timelines and deadlines, making sure every individual received the quality of care that is needed, responsible for all inventory coming in and out of the establishment
• Verifying Insurance benefits, explaining coverages, and process of the claim through the appropriate carriers
• Warm Lead sales calling, assisting in the booking and sales of new products, scheduling appointments
• Compiles and maintains client files
• Conducts interviews, managing the candidate pool, placing candidate in jobs, background checks, verifying credentials, and follows new applicant through processing the onboarding process, including to completion
• Ensures the employees remained in compliance with all state required training, regulations, and mandatory annual trainings
• Work with sites, patients, and multiple offices to investigate and resolve any complex scenarios, questions or concerns and preempt unanticipated issues
• Provide professional, courteous and accurate information to all callers and future customers and patients
• A strong customer service orientation and commitment to providing outstanding service
• Strong attention to detail
• Professionalism and a strong work ethic; the ability to excel and meet your responsibilities in a highly structured environment
• The ability to work independently and as a reliable team member
• An upbeat attitude with a coachable persona
• Inquisitiveness and the desire to continually learn and improve.

• Provides premium level service, removing burdens and providing end-to-end resolution for members
• This includes, but is not limited to: Clinical, Financial Decision Support, Behavioral Support, Claims inquiries, and more
• Manage large workload
• Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy / infertility plans
• Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
• Be a single point of contact for highly designated, dedicated UHC national or key account insurance plans
• Identify the areas of assistance and offer resolution for benefits, eligibility, claims, financial spending accounts, correspondence, Pharmacy, Behavioral Health and self-service options
• Claims adjustments
• Negotiations
• Educate members about the fundamentals and benefits of managing their health and well-being
• Assist in navigating UnitedHealth Group websites or applications utilizing remote desktop system capabilities
• Correctly analyze and adjudicate claims to reflect financial check and processing accuracy
• Construct communication via secure messaging, e-mail or chat
• Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues
• Navigate through multiple platforms and databases to retrieve information regarding medical plans, prescription plans, flexible spending accounts, health reimbursement accounts, vision plans, dental plans, employer-based reward plans, claims submissions, clinical programs, etc
• Work with multi-faceted systems and analytical skills
• Meet the performance goals established for the position in the following areas: effectiveness, efficiency, call quality, member satisfaction, first call resolution, and adherence
• Additional Responsibilities:
• Performs claims adjustments/dollar payments to providers and/or members ultimately impacting UHC costs or commercial account costs
• Effectively explain costs, adjustments, and payments to providers and members
• Effectively refer and enroll members to appropriate internal specialists and programs, based on member’s needs and eligibility using multiple databases
• Must remain current on all communicated changes in process and policies / guidelines
• Adapt to all process changes quickly, and maintain knowledge of changes at site level and entity level by utilizing all available resources
• Maximize use of community services, support programs, and resources available to member

• Provides premium level service, removing burdens and providing end-to-end resolution for members. This includes, but is not limited to: Clinical, Financial Decision Support, Behavioral Support, Claims inquiries, and more.
• Manage large workload
• Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy / infertility plans
• Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance.
• Be a single point of contact for highly designated, dedicated UHC national or key account insurance plans.
• Identify the areas of assistance and offer resolution for benefits, eligibility, claims, financial spending accounts, correspondence, Pharmacy, Behavioral Health and self-service options
• Claims adjustments
• Negotiations
• Educate members about the fundamentals and benefits of managing their health and well-being
• Assist in navigating UnitedHealth Group websites or applications utilizing remote desktop system capabilities
• Correctly analyze and adjudicate claims to reflect financial check and processing accuracy.
• Construct communication via secure messaging, e-mail or chat
• Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.
• Navigate through multiple platforms and databases to retrieve information regarding medical plans, prescription plans, flexible spending accounts, health reimbursement accounts, vision plans, dental plans, employer-based reward plans, claims submissions, clinical programs, etc.
• work with multi-faceted systems and analytical skills
• Meet the performance goals established for the position in the following areas: effectiveness, efficiency, call quality, member satisfaction, first call resolution, and adherence

Additional Responsibilities:

• Performs claims adjustments/dollar payments to providers and/or members ultimately impacting UHC costs or commercial account costs
• Effectively explain costs, adjustments, and payments to providers and members
• Effectively refer and enroll members to appropriate internal specialists and programs, based on member’s needs and eligibility using multiple databases
• Must remain current on all communicated changes in process and policies / guidelines.
• Adapt to all process changes quickly, and maintain knowledge of changes at site level and entity level by utilizing all available resources
• Maximize use of community services, support programs, and resources available to member