Veteran Care Representative

at  UPMC

VETERAN CARE REPRESENTATIVE

Job ID: 6056326284
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Pinnacle
Department: Veteran SVC
Location: 409 South Second Street, Harrisburg, PA
Union Position: No
Salary Range: $ 18.68-28.03 USD
Join our team of Life Changers!
UPMC is hiring a Full-Time, Veteran Care Representative to support the office in Harrisburg.

QUALIFICATIONS:

• High School diploma required.
• Additional training in a medical setting or field with a knowledge of basic medical terminology is preferred.
• Four years of experience working in a health care environment preferred or an equivalent combination of education and experience.
• Strong interpersonal and communication skills, and computer literacy/data entry skills are required.
• High level of independence required in problem solving activities.
• Strong organizational skills that will generate efficiency & effectiveness.
• Adaptable to change.
• Ability to handle multiple tasks in a fast-paced environment & function independently.
• Must be able to prioritize referrals.
• Ability to analyze issues objectively & provide workable solutions & implement those actions with support of supervisory team.
• Team player, flexible, and innovation oriented are ideal.LICENSURE, CERTIFICATIONS, AND CLEARANCES:

Clearances must be dated within 90 days

• Act 34

PURPOSE:

The purpose of the Veteran Care Representative is to serve as the primary point of contact for the veteran patient, Veterans Affairs Medical Center, and the referred service line. The staff member provides direct support for the onset of care coordination when the veteran is referred on a valid authorization from the VA medical center into UPMC through the continuum of care.

RESPONSIBILITIES:

• Manages incoming calls from clinics, patients, and VA Medical Centers, in-basket messages, and emails on a timely basis.
• Receives referrals from VA Medical Centers.
• Conducts review of documentation ensuring all aspects of required documentation are present.
• Requests additional required documents as needed.
• Processes all aspects of referrals from the initiation of the referrals in the utilized electronic medical record, to include, but not limited to, transcription of orders, uploading of all documents, annotation of all required documentation, adjusts and correct insurance filing orders and location of services.
• Updates all insurance information, demographics, and billing information.
• Assists with patient portal requests.
• Utilize associated data platforms from external agencies to retrieve referrals (HSRM).
• Aspects of appointment scheduling: Schedules appointments across all service lines, creates and assigns referrals, creates and assigns HAR, adjusts permanent patient notes, addends clinical schedule and appointment notes.
• Coordinates with service lines for all required services to include appointments, records, and care coordination between entities.
• Coordinates with business units to ensure coverage of services through research of valid referrals.
• Accurately documents all aspects of care coordination through the EMR, Teams Tracker, and portal with patients and staff.
• Maintains referral log accurately and utilizes such to accurately inform VA medical centers and patients of accurate locations of services to include TIN/NPI.
• Assigns referrals to future appointments, adjusts filing orders, advises of benefits to patients, adds permanent comments in chart, coordinates directly with the community VA medical centers for care through the utilization of Request for Services forms in concert with the requesting department.
• Coordinates with external and independent healthcare providers when veterans are utilizing shared VA authorizations.
• Reviews procedures requested by agencies regarding coverage based on CPT coding.
• Returns required information for approval, next steps, or declination by the VA medical center.
• Supports service line staff with claim edit work queue errors.
• Assists patients with billing questions related to referrals and communicates patient billing inquiries to the Professional or Hospital Billing Office.
• VA Medical Center Support: Assists patients with billing questions related to referrals and communicates patient billing inquiries to the Professional or Hospital Billing Office.
• Assists veteran in enrolling in VA coverage through the coordination with embedded Veterans Affairs medical center community liaisons.
• Utilizes VA medical center staff to confirm eligibility for services.
• Communicates issues to service lines and supervisors as necessary regarding coverage.
• Assist in submitting emergency and inpatient authorization requests.
• Appropriately utilizes supervisory team for outlier issues, problems, or difficulties.
• Performs in accordance with system wide competencies and behaviors.
• Performs other duties as assigned.