PATIENT CARE COORDINATOR -

Patient Care

• Assist patients in locating departments; schedule and coordinate patient appointments; refer patients and families to appropriate services and resources
• Identify Primary Care Physicians for all patients and communicate with the PCP as necessary; take messages for department personnel
• Acquire prior patient records, patient billing, referral information and lab results
• Assist referring providers in resolving problems, locate UNM physicians and forward documents
• May assist clinical staff with routine non-invasive patient treatment procedures and initial screenings

Prior Authorization

• Complete pre-screening process for specialty clinic appointments for referral and/or prior auth
• Verify coverage eligibility on patients needing prior authorization

Coding

• Abstract chart information and assign CPT, ICD, and HCPCS codes for purpose of predetermination or prior authorization

Liaison

• Perform as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/coverage and prior authorizations

Documentation

• Complete and fax paperwork and pertinent medical documentation to insurance companies and other payors for approval; document final prior authorization in financial systems

Financial Assistance

• Refer self-pay patients for financial assistance; make financial assistance appointments

Coordination

• Coordinate with hospital and clinic surgical representatives, providers, and other applicable areas for day surgery prior authorization and/or financial coverage or assistance

Training

• Perform outreach/training with clinical areas to ensure process flow remains tight and to maintain open communication

Denials

• Track and investigate payment denials due to "no authorization"; report detail information to supervisors and work with billing office representatives to coordinate appeal efforts

Customer Service

• May exercise functional and technical lead over lower level staff

Patient Safety

• Follow patient safety-related policies, procedures and protocols
• Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
• Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
• Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner
• Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"

Patient-Centered Medical Home

• Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable

Qualifications

• Essential: 2 years directly related experience
• Nonessential: Course in Medical Terminology within six months of position