Case Worker Outpatient

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.

Responsibilities

• 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.
• 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.

Requirements

• 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.
• 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