Wellness Program Manager jobs in Birmingham, AL

JOB DUTIES & RESPONSIBILITIES:

Resident Financial Functions

• Receive, review, and evaluate all referrals for potential admission to a Arabella facility, to determine financial eligibility and viability.

• Review the common working file for Medicare-funded referrals to determine Medicare eligibility.

• Communicate financial viability to the Admissions Coordinator and discuss medications, equipment, and other special needs that impact the cost of care.

• Prepare a cost projection for all financially viable referrals to Arabella facilities, based on the determination of clinical and other needs (as identified by the Admissions Coordinator). Determine Medicare Part B coverage prior to the initiation of therapy services by the therapy vendor.

• For all referrals who will convert to Medicaid during the length of stay, determine whether or not the Medicaid application process has been initiated; Work with the referral source and family to initiate the process if not yet begun. Review the state’s home page to determine whether or not the referral currently has property or has recently transferred assets which would prevent Medicaid eligibility. Initiate Medicaid-pending tracking log.

• Ensure the timely submission of all required assessments and documentation related to Medicaid eligibility (PAE, PASARR, DMAS, FL-2, etc.). Ensure that these forms are updated and resubmitted as necessary.

• Determine the need for and obtain pre-authorization for managed care payers including those for primary, secondary, and ancillary services. Ensure that required ongoing authorizations are obtained by facility clinical staff.

• Collect all upfront monies due upon admission.

• Ensure the collection of all private pay balances as they become due and payable.

• Ensure that resident admission contracts are signed and appropriately filed.

• Ensure appropriate supporting documents are scanned into the electronic medical record (consent to treat, common working file (CWF), copies of insurance cards, etc.) Verifies and records specific ancillary charge information as directed by the corporate office.