Case Worker Outpatient

Rhode Island Hospital; United States; On-site; USD 28,000 - 45,000; Full time

Job summary

Gateway Healthcare Inc. is seeking a Referral Coordinator for CAFOS to process client referrals and ensure accurate entry of authorizations and care episodes in LifeChart. You will collaborate with support staff and billing to resolve issues affecting billing and reimbursement.

Under supervision, you'll generate reports, assist with grant data tracking, and help with program leadership. The role emphasizes compassionate, accountable, respectful, and excellent service in daily interactions with

Qualifications

• A Bachelor's degree in social work, psychology or healthcare administration accompanied by at least one year of relevant experience.
• Bilingual in Spanish preferred; knowledge of community resources specific to the cultural needs of the community preferred.
• Demonstrated ability to interact professionally both on the phone and with colleagues.

Responsibilities

• Coordinate CAFOS referrals by responding promptly to inquiries, providing intake dates, verifying insurance eligibility and benefits with Client Registration, and maintaining clear, helpful communication with clients and families.
• Enter and maintain accurate client opening and closing information in LifeChart, including authorizations, episodes, care team assignments, and related records.
• Collaborate with clinical staff, clinical leadership, and billing to identify and correct documentation, episode, linking, caseload, and charge-code issues that prevent accurate billing or reimbursement.
• Prepare and provide reports to managers and clinical leadership to support performance improvement, monitor documentation due dates and staff productivity, and identify operational trends.
• Participate in billing and clinical meetings to assess workflows and recommend process improvements that support timely, accurate reimbursement.
• Gather and analyze grant data for children's programs and assist with preparing required reports for funders.
• Support implementation of the Missed Appointment/No-Show Policy by reinforcing attendance expectations, addressing logistical barriers, communicating with patients and families, sending required notices, and coordinating with Risk Management and clinical leadership when discharge procedures are indicated.

Skills

Customer service

Professional communication

Spanish language (preferred)

Data entry

Education

Bachelor's degree in social work, psychology or healthcare administration

Tools

LifeChart

Excel

Job description

Under the supervision of the Clinical Director and Clinic Manager of Gateway Child and Family Outpatient Services (CAFOS), coordinate services by processing client referrals; ensuring that client authorizations and care episodes are accurately entered in LifeChart; collaborating with support staff; running LifeChart reports to monitor documentation; assisting with grant data tracking and report preparation; and working with the Billing and Clinical Services departments to resolve issues that prevent services from being billed or reimbursement from being collected from insurance companies.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

RESPONSIBILITIES:

• Coordinate CAFOS referrals by responding promptly to inquiries, providing intake dates, verifying insurance eligibility and benefits with Client Registration, and maintaining clear, helpful communication with clients and families.
• Enter and maintain accurate client opening and closing information in LifeChart, including authorizations, episodes, care team assignments, and related records.
• Collaborate with clinical staff, clinical leadership, and billing to identify and correct documentation, episode, linking, caseload, and charge-code issues that prevent accurate billing or reimbursement.
• Prepare and provide reports to managers and clinical leadership to support performance improvement, monitor documentation due dates and staff productivity, and identify operational trends.
• Participate in billing and clinical meetings to assess workflows and recommend process improvements that support timely, accurate reimbursement.
• Gather and analyze grant data for children's programs and assist with preparing required reports for funders.
• Support implementation of the Missed Appointment/No-Show Policy by reinforcing attendance expectations, addressing logistical barriers, communicating with patients and families, sending required notices, and coordinating with Risk Management and clinical leadership when discharge procedures are indicated.
• Follow all hospital and Outpatient Department policies, procedures, rules, and regulatory requirements.
• Maintain current information on community-based services and provide appropriate referral resources to active patients and their families and to patients transitioning from CAFOS services.
• Perform other duties as assigned by program leadership.

MINIMUM QUALIFICATIONS:

• A Bachelor's degree in social work, psychology or healthcare administration accompanied by at least one year of relevant experience.
• Bilingual in Spanish preferred; knowledge of community resources specific to the cultural needs of the community preferred.
• Demonstrated ability to interact professionally both on the phone and with colleagues.

NECESSARY SPECIAL REQUIREMENTS:

• Knowledge with Excel and ability to work in an electronic record.
• Excellent customer service.

SUPERVISORY RESPONSIBILITIES:

None

Pay Range: $19.97-$32.96

EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location: Gateway Healthcare Inc. - 101 Bacon Street Pawtucket, Rhode Island 02860

Work Type: 8-4:30 M-F

Work Shift: Day

Daily Hours: 8 hours

Driving Required: No