Care Coordinator II
The Care Coordinator 2 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:
- Trains new Care Coordinators and assists with training on new processes with direction from Referral Manager.
- Manages approval flows and follows up with approvers who do not respond within a 24 hours period.
- Communicates responses to Referral team.
- Provides coverage for Care Coordinators when calls-ins, PTO or unavailable and/or in times of high patient volume.
- Serves as a backup to the Referral Manager when unavailable.
- Assists Care Coordinators on complicated referrals.
- Assists with orders, as needed, per Referral Manager. Coordinates surgical procedures with Tier 1, 2 & 3 providers. Assists Skilled Nursing Facility (SNF) team with follow-up on orders.
- 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.
- Provides extraordinary customer service to all internal and external customers, including, but not limited to: patients colleagues, physicians, etc. at all times. Establishes and maintains relationships with service providers and clinicians.
- Ensures assigned tasks are completed precisely and accurately.
- Ensures Preferred Provider List is used accurately and effectively. Collaborates with referral management to ensure specialist network is adequate for the geography and escalates accordingly when network adequacy impacts access to care.
- Performs other related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of Microsoft Office (Excel and Word) required. An inept understanding of the company's patient population, including the complexities of Medicare programs to patients in the current healthcare marketplace.
- 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; Associate's degree preferred.
- 1-3 years of hands-on healthcare experience in a clinical setting required. Experience with Web IVRs and obtaining referrals/authorizations for multiple payors 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.