Job description

The Care Coordinator is a highly visible customer service and patient-focused role. The incumbent in this role works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel to ensure the referral process runs smoothly. He/She operates in a dynamic and professional environment to ensure the highest level of quality healthcare is delivered to our members.

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ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Coordinates and processes patient referrals to completion with precision, detail and accuracy.

Definition of completion:

• Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.
• Orders have been approved (when needed).
• Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.
• Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).
• Completes orders with proper documentation on where patient is scheduled and how patient was notified.
• Referrals have been sent to specialist office & confirmed receipt.
• Prepares and actively participates during physician/clinician daily huddles utilizing RITS Huddle Portal and huddle guide. Effectively communicates the physicians/clinicians needs or outstanding items regarding to patients.
• Enters all Inpatient and Outpatient elective procedures in HITS tool.
• Ensures patient's external missed appointment are rescheduled and communicated to the physician/clinician.
• Participates in Super Huddle and provides updates on high priority patients referrals.
• Addresses referral based phone calls for Primary Care Physicians panel.
• Completes and addresses phone messages within 24 hours of call.
• Checks out patients based on their assigned physician/clinician. (Note: If assigned Care Coordinator is unavailable at the time of check out, a colleague shall assist patient. This process does not apply to Care Specialist)
• Retrieves consultation notes from the consult tracking tool.
• Follows up on all Home Health and DME orders to ensure patient receives services ordered.
• Provide extraordinary customer service to all internal and external customers (including patients and other
• ChenMed Medical team members) at all times. Utilization of patient messaging tools.
• Performs other related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of medical terminology, CPT, HCPCS and ICD coding desired
• Detail-oriented with the ability to multi-task. Must be open to cross-functionally training in referrals and back office duties
• Able to exercise proper phone etiquette with the ability to navigate proficiently through computer software systems
• Team-oriented with the ability to work extremely well with patients, colleagues, physicians and other personnel in a professional and courteous manner
• Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software
• Ability and willingness to travel locally within the market up to 10% of the time
• Spoken and written fluency in English; Bilingual a plus

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EDUCATION AND EXPERIENCE CRITERIA:

• High School diploma or equivalent required
• A minimum of 1 year of relevant work experience in customer service, patient referrals, and/or insurance verification required
• Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred
• Healthcare experience in a clinical setting, preferably within the Medicare HMO population is a plus
• A valid, active driver's license in State of employment is required; position may require travel within the market
• Medical Assistant certification preferred
• CPR for Healthcare Providers is preferred

Job Type: Full-time

Pay: From $17.00 per hour

Benefits:

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

Schedule:

• 8 hour shift
• Monday to Friday
• No weekends

Experience:

• Insurance verification: 1 year (Required)
• Medical billing: 1 year (Required)

Language:

• Spanish (Required)

Work Location: In person

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