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Healthcare Patient Coordinator
2 months ago
Hours: 40 hours per week - Monday through Friday from 8:30 AM to 5:00 PM
Location: Onsite - Addiction Medicine
Position Summary
This role is dedicated to executing tasks related to assessing, formulating, recommending, and implementing policies and procedures that ensure the delivery of exceptional patient care. The focus is on performing Care Navigation duties, which involve understanding patient needs and guiding them through the healthcare system while addressing barriers to receiving necessary care and treatment. This position also encompasses organizational support or service roles, whether administrative or clerical, and involves assisting with daily business operations in a hands-on environment. The role requires experience and foundational knowledge of job procedures and tools, typically acquired through prior work experience or vocational training. It operates under moderate supervision, dealing with routine issues that may occasionally necessitate interpretation or deviation from standard protocols, and involves communicating information that may require some clarification.
Job Overview
The primary responsibility of this position is to manage incoming requests from patients and primary care providers for managed care referrals for patients with designated primary care physicians within the healthcare system. The main objective is to minimize the leakage rate to out-of-network providers while demonstrating exemplary customer service and interpersonal communication skills to exceed service expectations.
Key Responsibilities:
Minimum Qualifications:
1. High school diploma or equivalent.
2. One (1) year of experience in insurance, billing, or patient access within the healthcare sector.
Preferred Qualifications:
1. Two (2) years of experience in insurance, billing, or patient access within the healthcare sector.
2. Bilingual capabilities.
Core Duties:
1. Process all requests for referrals, specialist treatments, durable medical equipment, and therapies in accordance with the specifications set by various insurance providers.
2. Triage requests based on departmental guidelines, ensuring referrals remain within the network unless specific exceptional criteria are met; maintain a turnaround time of 3-5 business days for request completion.
3. Verify insurance coverage eligibility through the NEHEN system or directly via payer websites.
4. Collaborate with Physician Access Line staff to expedite appointment services for in-network referrals.
5. Engage the Manager as necessary according to departmental Referral Guidelines.
6. Maintain referral data entry for General Medical Associates in the Logician Referral Management module; communicate with staff and/or primary care providers as needed for assistance in processing requests.
7. Keep a log of Community PCP referral requests for out-of-network care and provide monthly statistical reports to the Manager.
8. Follow up with patients on all referral requests to ensure appointments are made and attended; assist with scheduling or rescheduling as directed.
9. Ensure that communication from specialists has been received; follow up to obtain notes from those who have not submitted them to the primary care provider.
10. Maintain knowledge of regulations governing the release of patient health information (PHI), including HIPAA, HIV, Mental Health, and substance abuse cases.
11. Stay updated on all insurance requirements that necessitate referrals and adhere to their referral management protocols.
12. Foster collaborative relationships with peers and colleagues to effectively contribute to goal achievement and promote a positive work environment.
Physical Requirements:
1. Frequent sitting, occasional standing, and lifting of 10-15 pounds.
2. Possible exposure to typical office discomforts.
3. Manual dexterity for computer keyboard operation.
4. Ability to see computer screens and read reports.
5. Ability to hear instructions from physicians and other clinical staff.
Skills & Abilities:
1. Proficiency in computer applications, including word processing and electronic spreadsheets, with an aptitude for learning new software.
2. Strong customer service skills, including excellent interpersonal and telephone communication.
3. High level of tact required due to frequent interactions with patients, physicians, and insurance representatives.
4. Solid business acumen, including an understanding of healthcare expenses, revenue, and reimbursement models and their impact on business strategies.
5. Ability to formulate recommendations based on analysis and lead teams towards decision-making.
6. Exceptional organizational skills with a keen attention to detail, along with the ability to prioritize tasks and adapt to changing work assignments.
