The Care Coordinator (Referrals/Authorizations Coordinator) is a highly visible customer service and patient-focused role that works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel in a dynamic and professional environment to provide the highest level of quality healthcare to our members.
ESSENTIAL DUTIES AND 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. Communicates effectively 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:
- Must be detail-oriented, possess the ability to multi-task and be open to cross-functionally training in referrals duties.
- The individual in this role must exercise proper phone etiquette and have the ability to navigate proficiently through computer software systems.
- Must be team-oriented and 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. Knowledge of medical terminology, CPT, HCPCS and ICD coding preferred.
Additional Job Description
EDUCATION AND EXPERIENCE CRITERIA:
- High School diploma or equivalent required.
- Up to one (1) year of relevant work experience 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.
- CPR for Healthcare Providers is preferred. A valid driver's license in State of employment is required; position may require travel within the market.