Patient Care Coordinator Advanced Lung Disease Institute

Position Summary

This position is responsible for providing personalized coordination, clarification and communication of all administrative aspects of care including patient needs assessments, insurance and authorization verification, registration, maintaining and handling of documentation, and scheduling of appointments. This position partners with the clinical care team to ensure a seamless experience for the patient and their family across the entire continuum of their treatment. This position assists with providing resources to help the patient maintain optimal care. This position performs follow-up tasks identified during the patient needs assessment for management of patients across the healthcare continuum or when the patient is in the continuum and needs additional resource support.

Core Functions

• 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.
• ACQUIRES 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, PROCEDURES AND SURGERIES AND MAY PROVIDE PATIENT WITH NECESSARY PREPARATION INSTRUCTIONS.
• PREPARES, PROCESSES, AND MANAGES PATIENT DOCUMENTATION TO DEPARTMENT DATABASE.
• ACTS AS A LIASON 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 CONTINUOUSLY 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 NECESSARY RECORDS.
• RESPONSIBLE FOR INQUIRIES FROM PATIENTS REGARDING REFERRALS 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.
• RECONCILES 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/PRACTICE ENVIRONMENT.

Responsibilities

• PERFORMS PATIENT INTAKE PROCESS, WHICH MAY INCLUDE PRE-REGISTRATION/REGISTRATION.
• 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.
• ACTS AS A RESOURCE FOR INSURANCE COVERAGE, WHICH MAY INCLUDE OBTAINING AUTHORIZATIONS AND NOTIFICATIONS THROUGHOUT THE PATIENT'S TREATMENT.
• MONITORS AND UPDATES INFORMATION REGARDING INSURANCE DATA, AUTHORIZATIONS, PREFERRED PROVIDERS AND CHANGES IN PATIENT'S TREATMENT PLAN.
• PREPARES, PROCESSES, AND MANAGES PATIENT DOCUMENTATION TO DEPARTMENT DATABASE.
• ACTS AS A LIASON 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 CONTINUOUSLY 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.
• MANAGES THE MEDICAL RECORD FOR THE ASSIGNED AREA, INCLUDING COORDINATION WITH HOSPITALS, PRACTICE OFFICES AND OTHER ANCILLARY SERVICES TO OBTAIN NECESSARY RECORDS.
• RESPONSIBLE FOR INQUIRIES FROM PATIENTS REGARDING REFERRALS 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.
• RECONCILES 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/PRACTICE ENVIRONMENT.

Qualifications

• HIGH SCHOOL DIPLOMA/GED OR EQUIVALENT WORKING KNOWLEDGE.
• SKILLS AND ABILITIES TYPICALLY ATTAINED WITH THREE OR MORE YEARS WORKING IN A HOSPITAL OR MEDICAL OFFICE.
• 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.
• ROLES SUPPORTING MOBILE MEDICAL UNIT REQUIRE TRAVEL WITHIN LOCAL COMMUNITY.
• REQUIRED KNOWLEDGE OF PAYER CONTRACT TERMS AND PROCESSES.
• REQUIRED THE ABILITY TO PERFORM BASIC MATH FUNCTION AND THE ABILITY TO HANDLE CONFIDENTIAL INFORMATION AND SENSITIVE ISSUES.
• MUST BE ABLE TO WORK EFFECTIVELY WITH COMMON OFFICE SOFTWARE AND HOSPITAL SOFTWARE TO PERFORM INTAKE AND UPDATES TO PATIENT MEDICAL HISTORY IN ADDITION TO OTHER SOFTWARE USED IN SCHEDULING AND BILLING.