Compliance Support Specialist - Coordination Care

TriHealth•Cincinnati, OH

About The Position

Why Join TriHealth? Join a team that makes a real impact on patient care. In this role, you’ll support our Utilization Management and Care Management teams by ensuring authorizations, documentation, and discharge planning run smoothly. You’ll help coordinate communication between payers, care teams, and facilities while keeping critical patient information organized and accurate. If you enjoy meaningful work, staying organized, and helping support seamless patient transitions, this role at TriHealth offers a chance to make a difference every day. Work hours: Full time, 80 hours biweekly Day shift No weekends or holiday commitment Incentives & Benefits: We offer competitive shift differentials, opportunities for professional growth, and a comprehensive benefits package that may include medical, dental, vision, paid time off, retirement savings plans, and tuition reimbursement. For more information, please visit our benefits page: https://careers.trihealth.com/what-we-offer/benefits Job Requirements: Associate's Degree. Equivalent experience accepted in lieu of degree. Advanced computer skills, data entry and results reporting, office organizational skills, and medical terminology Excellent oral and written communication skills 3-4 years of clerical experience in office, hospital, or care delivery. Up to 1 year experience in Healthcare either in a hospital or community agency Job Overview: This position provides support and clinical assistance to the Care Management Department. Support includes secretarial and office management and the following specific functions: discharge planning assistance for DME and homecare referrals and contact to ECFs for finalizing plans. This position assists the care management RN’s and social workers in assuring that all technical documentation details are met for compliance with MCR and payor guidelines. This position performs secretarial, clerical, receptionist and office management functions. This position receives, organizes and communicates verbal, written information in timely manner. Responsibilities include interaction with multiple systems including payer specific electronic systems, ECIN and Meditech, retrieving approval/certification of days and communicating this to the health plan, care coordinator and billing. The position also includes responsibilities necessary to department statistical reporting and the department quality improvement activities.

Requirements

Associate's Degree. Equivalent experience accepted in lieu of degree.
Advanced computer skills, data entry and results reporting, office organizational skills, and medical terminology
Excellent oral and written communication skills
3-4 years of clerical experience in office, hospital, or care delivery.
Up to 1 year experience in Healthcare either in a hospital or community agency

Responsibilities

Assists with the coordination of discharge plans at the direction of the CC/SW, payer, provider and patient as indicated.
Arranges transportation under the direction of the CC/SW.
Attends staff meeting and in-services.
Participates in teambuilding exercises as indicated.
Engages in educational opportunities to maintain professional competence.
Collects information to identify admissions, discharges, daily patient transfers and cases requiring follow-up by CC or SW.
Supports CC/SW by assisting with completion of forms as needed.
Obtains pre-certification or benefit information for homecare, DME, transportation at direction of CC/SW.
Responds to payers as directed by CC/SW.
Enters/retrieves electronically submitted clinical reviews.
Retrieves admission and discharge reports daily.
Manages authorization and denial notifications from payers and inputs information into EMR.
Performs clerical and office management functions for the UM department.
Reviews departmental voicemail as outlined in daily workflow.
Secures meeting rooms when asked.
Navigates required software to communicate with fellow team mates.
Keep email open all day for timely communications.
Works with other UM CSS team members to perform daily tasks.