EMP Medical Services, Inc. We make it our business to care. Home Health Care Management

Job Description:

Home Health Case Manager

Job Summary:

Manages the treatment plan and utilization for all members receiving Home Health Care Infusion Services.

Duties and Responsibilities:

Duties of the Case Manager include, but may not be limited to:

1.      Verifies medical documentation to ensure member meets home health    benefit criteria.

2.      Receives updated orders and medical information from all referral sources, i.e. Hospitals, Physician’s offices, Skilled Nursing Facilities, Rehabilitation Centers, Health Plans, PHOs, CM Departments, Home Health Agencies and others.

3.      Evaluates the need and appropriateness for continued services.

4.      Monitors and manages physician’s orders to ensure satisfactory outcomes.

5.      Provides authorizations to the home health agencies in a timely manner.

6.      Serves as a liaison between the health plan, the members, the member’s family and the agencies.

7.      Maintains active list on all health plans.

8.      Document and resolve first line patient treatment plan.

9.      Input the pertinent information and authorization into the appropriate software.

10.  Maintain Referral files.

Qualifications:

1.      Three years of Managed Care experience.

2.      Bilingual (English/Spanish)

3.      Effective verbal and written communication skills.

4.    Computer literate



Job Description:

Receptionist

Job Summary:

Operates multi-line telephone system to answer incoming calls and directs callers to appropriate personnel.

Duties and Responsibilities:

Duties of the Receptionist include, but may not be limited to:

1.      Answers incoming telephone calls, determines the purpose of the call, and forwards to appropriate personnel or department.

2.      Receives and records messages, placing in correct message slot for distribution, as necessary, to correct department or personnel.

3.      Answers questions about the organization and provides callers with the company address, directions and other information.

4.      Welcome on-site visitors and announce visitors to appropriate personnel.

5.      Assist client services department on next day call program and ACD report

6.      Assist the claims department in processing claims eligibility.

7.      Performs other duties as required

8.      Complies with all applicable CMER policies and procedures

Qualifications:

1.      High school graduate or equivalent.

2.      Effective verbal and written communication skills.

3.      Multi-line telephone experience/on the job training

Finance Department – Sr. Leadership position

 

• Monitors financial performance of health plan contracts, reporting to  Executive Management on a regular and ad hoc basis, making recommendations to improve financial, accounting and/or operations functioning. (Production of weekly/monthly/quarterly trend analysis or standard reporting)
• Works with and assists department heads throughout the organization on forecasting, monitoring and reconciling actual financial performance against expectations/budget and related reporting/information (Calculation of Unit Cost Change Factor and Production of Contract Retro Review Analyses)
• Work with department heads to determine business needs and develop operating & capital budgets.
• Develops and researches costing for DME, HH, HI services and  maintains standard pricing for each service area in coordination with CEO & senior leadership.
• Provide analytical support and assistance in the development of pricing for prospective health plans.
• Liaison to the Network Management and Claims Department(s) to ensure proper and timely claim payment. (Develop / Update Medicare Fee Schedule)
• Analyze costs and determine impacts to free cash.
• Recruits, develops and motivates staff. Initiates and communication a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions
• Promotes a team environment and supervises and develops subordinates.
• Overall financial statement review (trend, month-over-month, year-over-year, variance analysis) to ensure the accurate and timely reporting of accounting information
• Oversight of the retirement asset management initiatives.
• Works closely with the finance / accounting group to ensure statutory and health plan deposits are maintained.
• Prepares federal and state income tax returns.
• Prepares quarterly federal and state estimated tax payments.
• Ensures analysis, reviews and management of the tax calculations of the investment system.
• Works closely with investment accountants to ensure investment accounting tax laws are being followed.
• Researches current and new tax laws to develop and recommend procedure changes.
• Analyzes, reviews and manages the tax books of the fixed asset system.
• Prepares year end fixed asset tax work papers for federal and state income tax returns.
• Coordinates, manages and reviews personal property tax return preparation by accountants.
• Maintains tax accrual used in monthly financial statements.
• Prepares quarterly tax account analysis.
• Analysis of accounting entries and preparation of complex account reconciliations
• Claims  Accounting and Analysis

 

Requirements

 

§  Technical accounting knowledge acquired through 9+ years of public accounting or equivalent health care/managed care experience

§  CPA/MBA required 9+ years of public accounting and private industry experience with Big 4 Audit Firm experience preferred

§  CPA license (or in process of obtaining) preferred

§  Prior management experience preferred

§  Candidate must have excellent communication skills