Patient Care Coordinator

Patient Care Coordinator

It is our goal to provide the finest Orthopaedic care possible. This philosophy requires that all office staff and providers be sensitive and responsive to patients’ needs and preferences. To ensure that we hire and retain the quality of staff needed for implementing our philosophy of service, we have adopted the following job description for this position. The position requires that the employee be available forty hours per week, and that also the employee be flexible in his/her schedule to provide efficient service for the group. The employee however, will be expected to work no more than five days per week. Many of the responsibilities require that you have a working knowledge of computers and the ability to learn the proper use of the programs utilized in this office, or those that which may be necessary to meet the needs of the practice. The hours, pay scale, and benefits will be defined as agreed upon.

RESPONSIBILITIES: Work is primarily performed in the Clinic located in Arrowhead Orthopaedics offices. The quality of duties performed is needed to be at a high level. The employee will come into contact on a daily basis with confidential patient files. The Patient Care Coordinator must be able to handle this information with the highest degree of privacy, discretion, and professionalism. The Patient Care Coordinator is responsible for accomplishing the duties set forth below:

• Confirm that insurance policies are active and registered correctly for the scheduled DOS.
• Update patient insurance information, including copayments and financial obligations due at time of service.
• Communicate with patients regarding high deductibles and cash rate amounts due.
• Notify patients of any issues with insurance verification or policy termination and provide options such as updating insurance or discussing cash rates.
• Add pop-up alerts for the Front Office when additional insurance information is needed or when patients are unreachable.
• Request and obtain follow-up visit authorizations via insurance carriers, online portals, or primary care providers.
• Secure authorizations for new patient visits via insurance carriers, online portals, or primary care providers.
• Create and manage referral modules based on authorizations and link them to the upcoming appointments.
• Follow established workflow
• Obtain pre-certifications/authorizations for recommended treatments via insurance carriers, primary care providers, or online portals.
• Use Healow Messenger to notify patients when treatment requests are submitted and when approvals are received.
• Follow up on submitted requests within 7–14 days.
• Route approved authorizations to he patient’s chart for processing.
• Coordinate care by faxing approvals and treatment orders to appropriate facilities and informing patients of the next steps.
• Notify medical assistants, providers, and patients of any treatment denials and schedule necessary follow-up appointments.
• Follow established workflow for Workers' Compensation treatment request and delays.
• Resolve treatment orders within 14 days; no orders should remain open past 30 days.
• Will be responsible for scheduling or rescheduling appointments based on treatment coordination, insurance eligibility, or authorization issues.
• Follow established workflows when booking appointments.

RELATIONSHIPS: The Patient Care Coordinator should observe and conduct the following relationships:

• The employee shall be responsible directly to the Patient Care Coordinator Manager. The employee shall report to the Patient Care Coordinator Manager and his/her assignees any progress, reports, requests, concerns, problems, and/or expectations in relation to the responsibilities of the position. Such communication may be verbal or written as deemed necessary by the employee or as directed by the Patient Care Coordinator Manager or his/her assignee.
• The employee shall interact with other office and clinical staff in the Practice. Such interactions should be collegial, professional, and contributing to the safety and pleasantness of the work environment at Arrowhead Orthopaedics.
• The employee shall interact with patients, medical groups, adjustors, nurse case managers, hospitals, and Primary Care Physicians and their offices. Such communication should always reflect the total commitment of the office to quality care and customer satisfaction. All communication should be professional and any unresolved conflicts are to be reported to the Patient Care Coordinator Manager

This job description in no way states or implies that these are the only duties to be performed by this employee. The Patient Care Coordinator will be required to follow any other instructions and to perform any other related duties as assigned by the supervisor and his/her assignees. Arrowhead Orthopaedics reserves the right to update, revise or change this job description and related duties at any time.

Requirements

Skill Requirements

• Education: High school diploma or equivalence.
• The ability to type 40 words per minute.
• Skill in operating a computer and scanner, as well as software programs including Microsoft Outlook and preferably Practice Partner.
• Telephone etiquette, superior customer service, and professional communication skills are required.
• Must be flexible and able to multitask in a stressful setting.
• Bilingual English/Spanish

Typical Physical Demands

• Requires sitting and walking, with daily occasional stooping, reaching, and bending.
• Occasional lifting up to thirty pounds.
• Hearing must be in the normal range for telephone and personal communication.
• Requires manual dexterity sufficient to operate keyboards and other office equipment.