Care Coordinator/Referral Coordinator

To coordinate continuity of patient care with healthcare organizations, facilities, patients and families while promoting clear communication among all care teams. To assist our providers in the treatment and management of patient care. Will obtain authorizations for patient referrals to specialists, diagnostic testing and surgeries. Collect and verify insurance authorization requirements to ensure payer requirements are met in a timely manner. Effectively communicate with internal and external customers including medical providers, clinic staff, and insurance companies. Maintain ongoing tracking and appropriate documentation on referrals and authorizations via the EMR/EHR.

DUTIES:

1. Assist all patients acting as a patient advocate while complying with HIPAA.

2. Participate in PCPCH/RHC team meetings and quality improvement initiatives including data collection, health outcomes reporting, clinical audits, programmatic evaluation, and process evaluation.

3. Assist all clinical staff in daily patient interactions as needed.

4. Provide triage using the Clear Triage program and schedule patients accordingly.

5. Monitor communications to and from the fax machine and electronic system as well as scan documents into EHR as needed.

6. Promotes clear communication among the care teams and treating providers by ensuring awareness regarding patient care and concerns.

7. Assist in the maintenance of changing specialist, health care organization, and insurance information as needed also while verifying the updated information is sent to appropriate parties in a timely manner.

8. Maintain relationships with health organizations and community resources that are in the best interest for FHA.

9. Maintain proper knowledge of CPT/Diagnostic codes, insurance and vendor sites for processing prior authorizations including but not limited to the following: workers compensation, diagnostic imaging, medications prior authorizations, outpatient care, DME, Home Health, referrals, lab ordering, surgical care and Interpath billing corrections, verify insurance coverage and authorization requirements.

10. Obtain and send medical records from various sources as needed for continued quality patient care and in compliance with HIPAA.

11. Manage process for completing incoming patient forms including but not limited to: WIC, DMV, FMLA, workers compensation, patient assistance forms, physicals, disability, prior authorizations, Cologuard, etc.

12. Monitor all assigned work queues and processes ensure that referrals and authorizations are responded to in a timely manner.

13. Assist in creating, processing, clarification, and the correspondence of all orders and prescriptions for patient care including but not limited to: pharmaceutical, DME, sleep studies, respiratory care, diagnostic, laboratory, home health, hospice, oximetry, referrals etc.

14. Monitor pain management agreement in conjunction with FHA policy, state and federal law.

15. Prioritize and communicate patient and provider concerns while making appropriate decisions regarding communication and coordination of follow up.

16. Manage an individual desk setting by scheduling patients, computer data entry, task management including but not limited to the following: patient call back messages, prescription requests, results, referral messages, staff messages, processing prior authorizations, and other items outlined by the clinic. Also, the management of incoming and outgoing phone calls, proper documentation within the EHR, following Rural Health compliance, PCPCH and HIPAA guidelines, and monitoring provider schedules.

17. Work under the general supervision of a licensed healthcare provider (MD/DO, NP, PA).

18. Assist and train others as needed.

19. Provide assistance and coverage for specific duties when providers and other clinical staff is out of the office.

20. Maintain regular work attendance and punctuality.

21. Comply with HIPAA and OSHA guidelines at all times to ensure patient and staff safety.

22. Work in a cooperative manner with management/supervisor, coworkers, and patients.

23. Abide by company policies and procedures.

24. Other duties as assigned by MA Lead/Clinic Supervisor.

QUALIFICATION:

1. A minimum of one year experience in a healthcare setting, healthcare insurance company, or managed care organization is required.

2. Knowledge of medical terminology, CPT procedure and ICD-10 coding required.

3. Current BLS Certification.

KNOWLEDGE/SKILLS/ABILITIES

1. Communication - Effective written and oral communication skills to explain complex issues, exchange information between team members, and tactfully discuss issues.

2. Adaptability/Flexibility - Ability to respond quickly and appropriately to situations that may arise with high risk or diverse patient populations. Ability to adjust actions in relation to others and adapt to offer best possible care to patients.

3. Conflict resolution - Ability to proactively resolve conflicts in a positive and constructive manner. Possess the knowledge and skills to handle complaints, settle disputes, and negotiate with others to reach mutually beneficial decisions.

4. Problem Solving - Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.

5. Time Management - Ability to organize, plan and prioritize work to complete within required time frames and to follow-up on pending issues. Ability to perform multiple tasks simultaneously and thrive in dynamic fast-paced environment and under pressure.

6. Compliance - Ability to evaluate information to determine compliance with laws, regulations, or standards.

7. Oral communication skills and excellent phone etiquette with an ability to convey and receive information via telephone.

8. Ability to react calmly and effectively in emergency situations and to work under pressure.

Job Type: Full-time

Pay: $21.50 - $25.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• High school or equivalent (Preferred)

Experience:

• Customer service: 1 year (Preferred)
• Medical and Medication terminology: 1 year (Preferred)
• EMR systems: 1 year (Preferred)

Work Location: In person