As the premier provider in healthcare outsourcing, Connext prides itself on custom solutions for healthcare companies of all types and sizes. Here are some sample functions and roles we have filled for a specialty pharmaceuticals company.
IV Nursing Department (nurses):
- IV Nursing SOC calls & compliance survey
- Medical Necessity Documentation faxing orders to agencies;
- SHP reporting;
- sending Auth requests
- IV New Referrals Master list
- Confirming AIS appointments.
- Initial Medical Necessity Documentation
- Tracking Nursing Agency visits and Communication with Nursing Agencies via Sfax/ phone call
- Confirming visits AIS
- Processing nursing agency visit notes
- Handling SNV and flight invoices
- Communication with Nursing Agencies via Sfax/ phone call
- Tracking Nursing Agency visits
- Creating billing packets
- Confirming Nursing agency visits in clinician visits & process for billing.
- Confirming home visits home
- Specialty Infusion care plans with auth info
- Specialty Infusions tracking expired auth & Rx
Specialty Department (nurses)
- Processing of 24hr Intake referral form (calling patients to verify information, calling MD offices, assigning faxes and sending receipt of Referrals)
- Manage incoming patient phone calls to ensure >95% answer rate
- Following up on Specialty packets
- Rx refills & Consent Forms.
Nutrition Department (nurses):
- Checking Insurance Eligibility (HME/IV bucket list)
- Generating authorizations (all insurances)
- Communicating to Insurances via fax/phone call
- Authorization tracking
- Ohana IV therapy
- Stop loss checking & Nutrition On call support
- Enteral refill calls and delivery tickets
- Oral refill calls and delivery tickets
- Management of Incontinence/Oral New Referrals.
- Generating statements of medical necessity for Incontinence Therapy & Request for additional information (MD office calls).
- Start of Care follow up calls
- MD calls to follow up outstanding SMNs
- Clinical packets & Continued Medical Need & Request for additional information (MD office calls).
Billing
- Insurance calls and open claims
- Correcting denied claims
- Sending corrected claims
- Managing Patient statements
- Managing Denials in Waystar
- Checking claim statuses online-HHIN & Waystar Rejections
- Process refund Request
- Insurance notifications & correspondence
- Write-off/void/patient clean-up & facility statements.
- Billing AIS(reviewing before submitting)
- Posting for all Credit cards/Checks and cash payments
- Payment postings for insurance payments
- Payment postings for Central Pay
- AR Spreadsheet month end closing
Accounting (CPAs)
- Bank Reconciliations
- Journal entries & Reports
- AP Vendor management
- Statements Monitoring
- Preparation of Bergen Invoices
- Import File & Financial Statement Analytical Review
- Prepare VD-Weekly AR Cash Deposit Report
- Manual Invoicing & Financial Statement Preparation
Data Analyst
- Weekly SPC Active & New Referrals
- Weekly reporting: Profitability Report, Infusion Bucket Tracking Presentation, Secondary’s & Poster Report, Delivery Report; Unbilled Tickets & Unbilled Sales; Driver’s date; Weekly Profitability Report; Nutrition Productivity Report and DTs Breakdown;
- Executive Summary Presentation;
- Monthly & Quarterly Presentation.
- Retail Executive Summary
Healthcare outsourcing is growing rapidly and it is important that healthcare organizations find an ideal vendor who is knowledgeable and capable enough to customize their staffing and support needs. For more information on selecting a vendor, visit our resources page for vendor assessments and more. If you have questions or want to discuss how we can specifically help your healthcare organization, you can book a call with one of our consultants here.
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