Guillermina Gonzalez

Assisting case manager with hospital admissions, and skill admissions to be entered into system, assist with transfers, call hospital for patient status, run eligibility, handle large amount of faxes daily, answer inpatient related calls, processing authorization referrals, works with ezcap, work daily census. Check DOFR, OOA, Carve Out.

Assisted in processing referrals, transfers, and authorizations while maintaining effective telephone communication with callers.

Translates oral information into concise and accurate written documentation, Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards, Ensures all approved authorizations are entered accurately into the system, Maintain accurate and timely records in REA, Scan physician progress notes, reports, and records and attach documents to appropriate authorizations, Update and close cases in a timely manner, Communicate immediately any admissions to non-contracted or non-core facilities, Distribute face sheet immediately upon receipt and eligibility check to the appropriate nurse, Check all new admissions for Out of Area status, Review case statuses to ensure proper documentation and case closure.

• Inpatient: Process incoming Hospital facesheets in a timeless standard, included but not limited to checking DOFR for entities at risk, sending contracted providers based on risk, checking for any duplicate entry and checking for benefits when applicable
• Update and document information on EzCap, daily census calls, assisting case manager with submitting authorizations for discharge planning, checking eligibility, assist with transfers, managing skill nursing facilities, issuing LCD/NOMNC, requesting and obtaining DC summaries, and working on bed day error reports
• Outpatient: Placing post discharge calls to assist members with follow up appointments, assisting with authorizations in a timely manner, scheduling transportation, scheduling appointments, translating for members, daily contact with Health Plans, welcoming members into case management program, assisting with any changes for the HP, and faxing documents to PCP.