Clinical Coordinator - Patient Engagement Center

Department/Unit Patient Engagement Center Work Shift Day (United States of America) Salary Range $59,066.00 - $88,599.00 Role This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification. Responsibilities The Clinical Triage/Authorization Nurse will assist the Patient Engagement Center Pre-Service as the first point of contact for the Primary Care Pod (ADULT and Pediatrics) for assessment of need for sick visits and trigger words identified through patient or parent telephone calls, using a pre‑defined triage assessment provided by the respective clinics. Collaborates with Clinic Nursing Leadership to ensure patient requests and inquiries are managed timely and triage trigger words are addressed expeditiously. Ensures payers are prepared to reimburse for scheduled services in accordance with payer‑provider contracts, and works diligently to identify, mitigate, and prevent clinical denials. Contacts payers and providers via phone, portal, or fax to secure authorizations, reviewing medical necessity, responding to authorization concerns, and reconciling coverage‑related issues. Assists the Pre‑Service Team, primarily the Primary Care (adult and pediatric) PODS, to triage clinical complaints, trigger symptoms, and clinical inquiries appropriately and promptly. Uses benefits and order information to initiate and secure pre‑authorization in advance of service dates, demonstrating excellent knowledge of third‑party payer authorization portals. Communicates with physicians, patients, payers, Patient Engagement Center Representatives, and Authorization Specialists to obtain missing demographic, insurance, or clinical information required for authorization of scheduled services. Documents all payer communications thoroughly and disseminates payer decisions in a timely manner. Manages medical necessity as service necessitates, identifies patients needing Medicare Advance Beneficiary Notices (ABNs), and assists with maintaining Authorization Requirements by payer database to ensure accuracy by payer and product line. Reviews services being rendered to ensure the appropriate setting of care has been assigned by the physician’s office. Organizes work with multiple steps to ensure no scheduling or authorization needs are missed. Albany Med Health System is an equal opportunity employer. #J-18808-Ljbffr Albany Med Health System