QA Coordinator I

4 weeks ago

Mesa, United States HealthyU Clinics Full time
Job DescriptionJob DescriptionDescription:

Come join our team We're looking for a QA Coordinator to join our growing team

Care Coordinator

This position facilitates intakes, treatment planning, discharge planning, and personalized coordination of care for patients. Works collaboratively with the interdisciplinary treatment team to coordinate care and planning for patients. This position is responsible for a caseload that may require frequent communication. This position acts as an ambassador to community partners.

Essential Job Functions:

  • Educates and informs patients of consents for treatment, communication, and compliance.
  • Gather collateral information from the patient, their clinic, other providers, etc. to provide a more thorough assessment of what the patient’s immediate needs are for treatment.
  • Collaborates with the medical team to develop and implement an individualized person-centered treatment plan that is.
  • Actively coordinate care for patients to ensure services are coordinated with facility staff. Identify and address gaps in service needs for participating parties in service delivery to the patient and make appropriate recommendations to meet patients’ needs upon discharge.
  • Collaborate with interdisciplinary treatment team to engage, monitor, and communicate with the individual. Facilitate and lead regular case planning with the involved Provider as new information is gathered to ensure the most clinically appropriate patient disposition.
  • Document all services and patient activities in the medical record regarding assessment, interventions, coordination of care, treatment planning, and discharge planning.
  • Maintain a working knowledge of the Contracted Health Plan system and potential funding
  • Participate in individual and group supervision as required. Participate in ongoing education, including in- services, training, and other activities to maintain and improve competency. Demonstrate competency through post-testing, skill observation, and performance as assessed by direct supervisor.
  • Performs all other duties as assigned.
  • Performs patient intake process, which may include pre-registration/registration. Partners with the clinical care team to determine initial authorizations needed based on the predicted care treatment plan. Obtains patient insurance benefit information for all aspects of the treatment, including, but not limited to, inpatient and outpatient services, prescription drugs, and travel and housing, if necessary. May also answer questions regarding the authorization process and supply information to providers, patients and third party payors.
  • Acts as a resource for insurance coverage, which may include obtaining authorizations and notifications throughout the patient's treatment. Obtains all necessary signatures and documentation required by the patient's insurance plan. Accurately and completely documents all information into the patient records system to ensure maximum reimbursement. Monitors and updates information regarding insurance data, authorizations, preferred providers and changes in patient's treatment plan. Partners with the clinical care team and insurance provider to ensure continued coverage of patient's care and maximum reimbursement and minimized financial impact to the patient.
  • Provides administrative support in maintaining materials such as documents, proposals, routine correspondence, spreadsheets, composing and preparing routine reports, and maintaining records in a variety of business software and database applications for electronic medical records, billing, data management.
  • Schedules physician appointments, tests, and procedures and may provide patient with necessary preparation instructions. Prepares, processes, and manages patient documentation to department database . Acts as a liaison between the patient, billing department, and payor to enhance account receivables, resolve outstanding issues and/or patient concerns.
  • Optimizes patient experience by using effective customer service. Communicates continually with patients, other departments, referral networks and providers to ensure appropriate plans and protocols are followed. Uses discretion and is attentive to issues of customer confidentiality. Demonstrates skills in pro-active resolution and attempts to resolve scheduling conflicts.
  • May manage the medical record for the assigned area, including coordination with hospitals, practice offices and other ancillary services to obtain needed records. Responds to patient referral requests for tests, procedures and specialty visits. Follows guidelines and may assist in developing procedures to ensure that medical records are in compliance with all state and federal laws. May also reconcile charge tickets, identifying incomplete tickets, missing charge codes or missing diagnosis codes. Notifies clinical staff as needed.
  • Works independently under general supervision, following established procedures. Uses knowledge and problem-solving skills to work independently in a clinic/physician practice environment. Responsibility for ensuring efficient coordination of administrative functions supporting patient needs assessments, insurance and authorization verification, registration, maintaining and handling of documentation, financial counseling, and scheduling of appointments. Internal and external customers include patients and their families, physician offices, third party payors, vendors, clinical staff, ancillary staff, therapist, nurses and case managers. Primary responsibility is to main department assigned, however cross-over and assistance to other departments is required. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
Requirements:

Minimum Qualifications:

  • Healthcare experience in clinical or administrative settings
  • Requires skills and abilities typically attained with three or more years working in a hospital or medical office.
  • Requires knowledge of medical terminology.
  • Must be able to work under minimal supervision and make independent decisions using good judgment.
  • Excellent communication, human relations, attention to detail and organizational skills are required. Must possess highly developed interpersonal relations and process coordination skills.
  • Requires knowledge of payer contract terms and processes.
  • Requires the ability to perform basic math function and the ability to handle confidential information and sensitive issues.
  • Must be able to work effectively with EHR software to perform intake and updates to patient medical history in addition to other software used in scheduling and billing.

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