Membership Services Medicare Coordinator

Membership Services Medicare Coordinator

At Virginia Garcia Memorial Health Center, we welcome diversity; we encourage, uplift, and are honored to serve people who have been historically underrepresented and underserved. Our mission is to provide high-quality, culturally appropriate healthcare to low-income residents of Washington and Yamhill Counties, with a special emphasis on seasonal and migrant farm workers and others with barriers to receiving healthcare. We strive to provide an inclusive environment that welcomes and values the diversity of the people we employ and serve.

If you are unsure whether you meet all of the required qualifications for this role but are interested and passionate about this potential position, we encourage you to apply.

Job Summary: The Membership Services Medicare Coordinator assists the Care Team (provider, medical assistant, nurse, behavioral health provider, etc.) by coordinating care for Medicare patients on the provider's daily schedule and by proactively managing and coordinating care for patients not on the schedule, so as to offer complete preventive care for all Medicare patients who are part of the assigned panel. They will act as a primary conduit for the transmission of information between providers and Medicare patients. The Membership Medicare Specialist coordinates services for all patients who are established Medicare patients, especially those with serious, complex or chronic health problems or with psychosocial issues, across the organization. This individual provides advocacy, information and referral services to patients and families to address their medical and psychosocial needs.

Essential Duties and Responsibilities:

• Review provider schedules and individual patient charts and assist the care team in coordinating care for visits and for future healthcare needs.
• Handle non-appointment related calls from patients. Resolve the reason for the call or route to the appropriate party.
• Provide an effective communication link between patient and medical staff, including relaying messages from providers, gathering information from patients for providers, etc.
• Use registry and other information to inform care team members of preventive care required for each patient seen each day.
• Ensure that all patients are tracked, and data entered into systems for follow-up and reporting.
• Regularly review registry information for assigned panel of patients and arrange for care needed to proactively coordinate healthcare needs.
• Coordinate with the medical staff to ensure that case management services are provided to patients with complex medical and/or psychosocial problems.
• Work with the medical staff to develop, implement and carry out programs in chronic disease management for patients, with such problems as diabetes, asthma, congestive heart failure, hypertension and depression, based on chronic disease management model.
• Assist in coordination of care with pharmacies, insurance companies and other providers in the community. Ensure that information goes when and where it is needed.
• Ensure that disease and other registry data entry is up to date and use registry reports to organize plan of care for complex patients on assigned panel.
• Participate in team decisions regarding data requirements for pro-actively managing the team's panel.
• Use and update the directory of resources in the service area to meet basic health and human needs. Be facile at using the resources available within the Center.
• Submit documentation in regard to Medicare quality health metrics to health plans through different portals.
• Meet with Medicare health plans on a monthly basis to track patient care needs and assess future outreach goals based on Medicare quality metric needs.
• Submit coded documentation to Medicare portals for risk adjustment and risk stratification.
• Perform other duties as assigned.
• Ability to handle protected health information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

HIPAA Requirements:

The Membership Services Medicare Coordinator will have access to PHI during the course of their work activities. The Membership Medicare Specialist will use this information to prepare both patients and medical records for visits with the provider and to keep the flow of work going smoothly in the clinic. Applying the minimum necessary standard of HIPAA, the designated records sets to which this employee will have access include: the full medical record and the EPIC Practice Management system.

Knowledge, Skills and Abilities Required:

Proficiency in verbal communication in English and understanding of basic written English.

Demonstrated ability to work effectively in a team environment.

Demonstrated problem solving skills in a complex environment.

Demonstrated effective interpersonal relationship and customer service skills.

Good organizational and time management skills

Good working knowledge of local social service resources or skills to acquire and use this knowledge and information expeditiously.

Desire to work with the Hispanic community and carry out the mission of the Center.

Ability to work effectively with people from diverse cultures and diverse socioeconomic situations.

Basic level of skill with Microsoft Word, Excel and ability to use other computer programs and applications (Epic, Practice Assist, etc) in ways that facilitate panel management.

Education and Experience Required:

One of the following is required:

o Associates Degree in Healthcare Administration, Social Science, Social Work, or related (preferred),

o Medical Assistant Certification, or

o Four years of experience in a healthcare or social service-related administrative role.

Two years prior experience working with underserved populations preferred.

Communication skills, spoken and written, equivalent to 2 years of college education.

Behavioral Competencies:

Accountability: Role model VG's mission, vision, and shared values

Customer-Focus: Listen to the voice of the customer and strive to delight them by exceeding their expectations

Teamwork: If someone needs help, help them

Initiative: Be innovative, apply fresh ideas, and continuously improve how you do your work

Confidentiality: Maintain strict confidentiality and respect the privacy of others

Ethical: Demonstrate integrity, honesty, and stewardship in all encounters at work

Respect: Demonstrate consideration and appreciation for co-workers and patients

Communication: Demonstrate the ability to convey thoughts and ideas as well as understand perspective of others

Physical Requirements:

• Standing: 5%
• Walking: 15%
• Sitting: up to 75%
• Lifting/Carrying: 5% - up to 40 pounds

Equipment Used:

• Computer: data entry, word processing and database programs, internet, e-mail
• Telephone, Fax, Copier

Immunization: Staff members must meet immunization requirements as stated in VGMHC's immunization policy and state and federal guidelines.

Job descriptions represent a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHC's Mission.

VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status, or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes affirmative action in placement, promotion, transfer, rate of pay, and termination.