Salome Tcheishvili

• PAIS will receive an inquiry via Payor issue, accept the inquiry and complete the initial intake process.
• If PAIS determines that received inquiry is the Request for Services (RFS), will review Payor Authorization, latest Plan of care, Service Authorization, latest CDPAS evaluation form, latest UAS-NY assessment.
• If determined by PAIS that Assessment Nurse (AN) home visit is required, PAIS will order new AN visit
• Generate a referral for CHHA SN/PT services following the eligibility criteria for CHHA.

• Review and revise IAD and approval notice to ensure that both the
  template and verbiage matches.
  Communicate with the Pre-Auth RN of any changes to be made. Attach
  IAD and approval notices in Guiding Care and submits them for mailing to
  members/providers. Finalize RFS process .
• Utilize the HHAeXchange system and Payor to update service
  authorizations .
• Assist with other projects assigned by management .

• As RFS group coordinator, enter and provide new service authorizations
  to vendors as approved by the Care Management team such as PCW and
  DME items. Enters initial authorizations in HealthRules Payor system .
• Communicate with Physicians and Care Managers to obtain prescriptions
  and letters of Medical Necessity, documentation, and processes all DME
  requests
• Follow up on all orders for DME with members to ensure timely delivery
  and placing appropriate documentation in the Care Management System.
• Utilizes the HHAeXchange system to update service authorizations for
  newly approved and changes in CDPAS/PCW service
• Generates broadcasts to secure provider placement for change in level of
  care requests

• Processe all newly enrolled cases according to established EP/HF
  Coordinated Care team workflows and maintains integrity of members'
  files
• Receive and process requests and inquiries through interdepartmental
  communication system regarding covered/ non covered services/supplies.
• Coordinate and provide service authorizations to vendors regarding
  Transportation services, Personal Emergency Response System (PERS).
• Vendor communication, coordination and/or authorization
• Assist in the initial and ongoing training of new/existing staff in relation to
  authorizations for MLTCP/MAP Medicaid/Medicare covered services.

Introducing to the client new products.
Assisting the clients in choosing the supply.
Helping in obtaining the all documents needed for getting the supply.
Receptively answered customer questions and helped locate desired items
in the medical supply.
Worked with all insurances in providing costumers need .
Contacting with doctors and insurances.
Ordering supplies.