Service Center Coordinator

Position Summary: The LRH Service Center employee plays a vital role in supporting patient care and operational efficiency across multiple practices. Team members are responsible for a range of functions, including phone reception, patient scheduling, financial advocacy services, and coordination of incoming and outgoing referrals.

Each Service Center employee will be assigned specific areas of responsibility. These assignments may rotate over time to promote cross-training and ensure well-rounded support. All team members are expected to contribute to the overall success of the Service Center by working collaboratively and providing cross-coverage as needed. This team-based approach helps ensure consistent service delivery and optimal patient experience.

Reports to: Director of Patient Access and Central Services; Manager of Patient Access and Central Services

Core Responsibilities:

• Understand and uphold the importance of exemplary customer service as emphasized by Littleton Regional Healthcare, performing job functions in alignment with LRH processes and organizational customer service goals.
• Demonstrate a positive and professional approach to always communicate effectively with both patient and team members.
• Comply with federal, state, and hospital requirements related to compliance issues
• Always adhere to departmental guidelines for dress code policy
• Maintain flexibility in work schedule availability, allowing the department to adjust schedules as needed to meet operational demands.
• Greet patients professionally with respect and compassion.
• Direct patients to the appropriate destinations with the hospital and practices
• Accurately collect demographic and financial information to support claims management and both administrative and clinical activities.
• Verify insurance coverage for scheduled tests and procedures in accordance with protocol.
• Collaborate with the department educator on performance-related matters through ongoing education and feedback.

Financial Clearance and Patient Advocate Responsibilities:

Service Center employees are also responsible for ensuring that patients are financially cleared prior to receiving services. This includes:

• Completing pre-registration for scheduled appointments
• Validating insurance eligibility and benefit details
• Providing price estimates, when applicable
• Offering or reviewing payment options with patients prior to service
• Communicating effectively with the patient and collaborating with the appropriate practice or department to resolve any outstanding financial questions

This comprehensive approach ensures that patients are well-informed and fully prepared prior to their visit. It supports operational efficiency, promotes patient satisfaction, and ensures all actions are performed in alignment with established practices and guidelines.

Medicaid Enrollment Specialist:

• Knowledge of Medicaid eligibility and budgeting guidelines
• Aid current and prospective consumers in relation to Medicaid enrollment or additional financial options available
• Conduct patient meetings to obtain the appropriate documentation required to determine which program a patient will be eligible for
• Process Medicaid or other applications and recertification for patients
• Investigate Medicaid issues related to eligibility, deferrals, denials and recertification
• Provide outstanding customer service, written and oral communication skills
• Call an insurance carrier to validate the patient benefits
• Meet with patients on the floor to determine qualification for Presumptive Eligibility
• Send all needed documentation in time frames set by Medicaid
• Set follow up meetings with patients
• Ensures appropriate signatures are obtained on all necessary forms
• Covers and assists with other office functions as requested
• Responsible for conducting eligibility screenings, assessing patient financial requirements, and counseling patients on insurance benefits and co-payments
• Serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management
• Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination
• Initiate and maintain proper follow-up with the patient and caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation
• Ensure all insurance, demographic and eligibility information is obtained and entered the system accurately
• Document progress notes on the status of patient's determination
• Participates in ongoing, comprehensive training programs as required. Follows policies and procedures to contribute to the efficiency of patient care

Switchboard:

• Receive and process incoming calls from patients, physicians, and other parties seeking access to LRH practices, personnel and provider appointments.
• Handle all calls in a timely, professional manner, and courteous manner.
• Promptly report any patient concerns or hospital-related issues to the management team for appropriate follow-up and resolution

Referrals and Scheduling Responsibilities

Referral Coordination:

• Process all incoming referrals for LRH physicians and providers, as well as outgoing referrals for Primary Care, Urgent Care and Occupational Health Services.
• Create and enter new referrals accurately and in a timely manner, ensuring that all pertinent information is obtained prior to scheduling, in accordance with clinic specific requirements.
• Ensure referrals are processed within the following timelines:
  • Standard Referrals: Within 48 hours of receipt.
  • High-Priority Referrals: should be handled on the same day, if received during business hours.
• Follow up on incomplete referrals using established protocols to ensure patients are contacted and scheduled appropriately.
• Send referral packets to new patients, including appointment details, as set forth by each practice.
• Determine whether a formal referral from the patient's Primary Care Provider (PCP) is required.
• Collaborate with clinical staff to process prior authorizations, if necessary.
• Update visit status and assign the referral appropriately, ensuring the PCP is notified as per protocol.

Scheduling Coordination:

• Schedule patients for appointments at all LRH practice locations, including Specialty Clinics, following provider-specific visit protocols.
• Monitor schedules to confirm appointments are scheduled to the appropriate locations.
• Notify patients of appointments that have been scheduled and request copies of films or prior testing as required.
• Verify insurance coverage for scheduled tests and procedures in accordance with protocol.
• Accurately verify and update patient demographics and insurance information in the EMR during scheduling

Communication and Documentation:

• Handle all telephone calls in a timely, professional, courteous, and helpful manner, minimizing reliance on voicemail, instead entering telephone encounters via the EMR.
• Enter telephone encounters into the EMR system and ensure appropriate follow-up. Create a clear and precise message, avoiding the use of abbreviations.
• Provide consistent, respectful communication with patients, internal staff, and external providers to facilitate seamless referral and scheduling workflows.

Prior Authorizations:

• Identify all patients requiring pre-certification or pre-authorization at the time services are requested
• Determines insurance company eligibility and benefits for requested services
• Follows up with the patient, insurance company, or provider if there are insurance coverage issues to obtain financial resolution
• Performs medical necessity screening as required
• Obtains necessary clinical documentation from the ordering provider to use in the prior authorization process
• Effectively communicates clinical information to insurance or prior authorization company to obtain authorization and/or certification for requested services
• Maintains familiarity with insurance carrier prior authorization requirements
• Partners with members of the Patient Financial Services department

Provider Build:

• Build new providers into the EMR in accordance with established policy and protocols
• Ensure encounter is updated appropriately to ensure a clean claim. (if applicable)

Qualifications:

• Minimum of two years in a previous healthcare office setting preferred
• High School education or equivalent with emphasis on business and computer courses
• Strong oral and written communication skills
• Computer Skills: Knowledge of Microsoft Office
• Computer Skills: Electronic Medical Records
• Good spelling and grammar knowledge are essential
• Basic medical terminology knowledge required
• Basic Health Insurance knowledge

Other:

• Other duties as assigned

Physical Demands : See physical demands analysis worksheet

Work Environment : Works inside a clean, well-lit and ventilated area. Works under emergent/stressful situations and may be required to deal with concerned/agitated patients and personnel.