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Clinic Care Coordinator

Category:

Clinic

Department:

Clinic

Description:

Job Summary: This position is responsible for the deliberate organization of prior authorization and referral activities between the care provider and any internal or external medication, diagnostic testing, referral sources, third party payors and community resources in order to facilitate the appropriate delivery of healthcare services and maximize reimbursement and patient satisfaction. The Patient Care Coordinator’s efforts are focused on performing prior authorizations, referrals to specialists, connecting patients to medication assistance programs, Labette Health Financial Assistance, Medicaid Presumptive Eligibility and other community resources.

Primary Job Responsibilities:

  • Work directly with the patient’s healthcare team to identify prior authorization and referral needs
  • Use Greenway tasking system to communicate with providers and nursing staff
  • Utilize Greenway referral management system to record progress and success of referrals and prior authorizations
  • Screen patients for eligibility of Labette Health Financial Assistance, Medication Assistance and Medicaid Presumptive Eligibility and complete necessary paperwork
  • Assist in facilitating adherence to Medicare requirements through knowledge of Medicare Local and National Coverage Determinations (NCD’s & LCD’s) and provide education to the provider/nurse/patient regarding these policies. Also assist in preparing and documenting ABN’s for patients.
  • Organizes necessary documentation to support the prior authorization and referral process
  • Coordinates Peer-to-Peer review process between ordering provider and third party payor
  • Utilizes resources such as CoverMyMeds, Availity, and other online prior authorization resources to efficiently carry out the prior authorization process
  • Advocates for the patient in order to assure successful completion of prior authorization and other financial assistance that the patient is eligible for

Education: High school diploma or GED, CNA/CMA or Medical Assistant Certification desired but not required

Experience: Minimum three years of experience in the medical or health insurance field preferred.

Other Requirements:

  • Knowledge of and fluency in Medical Terminology
  • Knowledge of and fluency in Pharmacological Terminology
  • Excellent customer service skills
  • Excellent telephone etiquette
  • Excellent interpersonal skills, including friendliness, empathy, patience, kindness, politeness and helpfulness
  • Skilled in Microsoft Word, Excel and able to adapt easily to EMR
  • Ability to build rapport with community partners in the medical neighborhood
  • Ability to work independently with a strong sense of focus
  • Task-oriented, strong organizational skills, ability to multitask
  • Strong attention to detail

Performance Requirements:

As a result of the Patient Care Coordinator’s efforts, we will see a reduction in the time spent by nursing staff in completing prior authorizations and referrals, letting them return to patient care. We will also see a reduction in the insurance denials due to missing prior authorization requirements.

Closing:

Open until filled

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