Practice Coordinator III

%

of time

Essential Function (Yes/No)

Key Responsibilities

(To be completed by Supervisor)

20%

Advanced New Patient Scheduling and Coordination

• Secures outside medical records and reviews them for completeness as assigned.
• Understands and is able to prioritize new patient scheduling based on diagnosis and current treatment status to ensure complex patients are scheduled according to practice priorities.
• Informs patients about possible treatment scheduling options.
• At new patient visits, as appropriate, meets with patient prior to or after visit to review health insurance and benefits options.
• Assists in registering patients into the hospital or clinic; provides assistance to patients in completing applications; makes referrals to Social Service agencies.
• Investigates payor requirements by obtaining benefits information, notifies insurance plans of patients treatment needs;
• Counsels patients about eligibility, billing policies, reimbursement programs, qualification standards, procedures and payment options;
• Assists patients and their representatives to apply for Medi-Cal, California Children Services and other Federal, State and County reimbursement programs;
• Communicates accurate financial reimbursement information and eligibility verification to health care professionals to aid in treatment planning;

30%

Advanced Revenue Cycle

• Secures complex insurance authorizations for services, medications, or testing and is able to track the authorizations for renewal based on insurance carrier driven limits of time frames or numbers of visits or services.
• Has demonstrated competency working with HCPC codes and is able to look up and locate the appropriate codes for the purpose of requesting authorization (e.g. J codes for medications like chemotherapy).
• Understands how to identify and interpret a patient's insurance benefit package, including pharmacy and mental health carve outs. Utilizes this information to direct authorization requests and to coordinate these services for patients.
• Reviews and analyses monthly denial reports for both professional and hospital billing. Initiates retro authorizations from denial report as indicated.
• Identifies trends in denials and works with practice team and supervisors to develop and implement improved workflows to minimize denials.
• Compiles and analyzes data for reports to track basic revenue cycle measurements such as charges, payments, visit volume, etc. and creates reports as directed.
• Oversees and coaches staff on complex authorization requests as they arise.
• Addresses patient complaints from patients regarding billing and complaints related to billing that come out of Patient Relations.
• Through reporting track patterns of billing complaints and identify patterns which can be addressed with coaching and education of staff and providers.
• Understands the managed care plans and is knowledgeable about the resources available to patients and staff in regard to knowing the specific requirements of individual managed care plans. Assists patients to understand the concept of managed care.
• Reviews all upcoming visits to determine patient eligibility and assists with identifying and initiating troubleshooting for patients who are no longer eligible for services in collaboration with the clinical teams.
• Acts as a department resource for insurance questions and insurance updates, including arranging for time to review updates with access team.
• Explains programs, qualification standards, policies, and procedure to patients; assists patients in completion of applications and forms when necessary; reviews and evaluates applications for completeness and accuracy; prepares patient budget to determine eligibility.
• Conducts interviews with patients, their relatives, and/or others in order to identify and determine patient eligibility for coverage of medical care under various Federal or State programs or under the provisions of private, fraternal, union or other health care plans; verifies hospitalization insurance and arranges for billing of the appropriate agency or health care plan; continually reviews patient's case files to update vital statistics.
• Obtains and provides medical and financial information with hospital staff, outside government agencies, and insurance providers;
• Determines patient eligibility for third party payment source according to established policies and procedures including private health insurance
• Investigates statements and information received from applicant through the use of telephone or written verifications.
• Reviews cases with supervisor in assessing the quality of payment source determination process and procedure.
• Answers questions and provides information to patient and the general public regarding assigned program area.
• Initiates and obtains approval of extension of Medi-Cal coverage for emergency and elective admissions
• Prepares records related to patient eligibility information and health care payment received; updates records in Electronic Medical Records (EHR); submits required reports.
• Refers non-payment cases to appropriate authority for recovery
• Utilizes procedures, methods and techniques of assessing and screening for eligibility for reimbursement from Medi-Cal, Medicare, and other public and private medical/financial assistance programs
• Prepares, updates, and maintains records related to patient eligibility information and health care payment received.
• Determines patient eligibility for third party payment sources according to established policies and procedures, including private health insurance plans, victims of crime, worker's compensation, and lawsuit settlements;

Moderate Complex Revenue Cycle

• Monitors provider(s) open charts and encounters and works with providers to complete encounter documentation in a timely manner to support revenue cycle. May assist providers with instructions on how to close encounters opened in error.
• Works work queues to secure information for accurate billing submissions or to respond to denials such as retro authorizations, clinical documentation, and addended authorizations with add-on CPT codes as needed.
• Secures authorization for procedures, specialty visits and ancillary testing and coordinates with Hospital Admissions Department as needed.
• Provides assistance with complex DME authorizations that require precise documentation in specific formats to receive approval.
• Provides assistance with medication authorization for new medications and refills.

10%

Advanced Check in/ Front Desk

• Performs front end office functions ranging from pre-registration, to registration, to referral processing, to authorization coordination and review, and scheduling functions.
• As needed or directed, develops and analyzes access team productivity reports in partnership with the management team to improve accuracy of registration functions.
• Identifies opportunities for productivity improvement and assists management team with staff coaching and workflow enhancement as directed.
• Represents the access team as the public face of the practice and works closely with the access and management teams to support practice operations and preforms customer service recovery and intervention efforts.
• Provides support to all functions of the access team to include message boards, referrals, Epic in-baskets, scanning, and filing.

20%

Advanced Administrative and Patient Care Coordination Responsibilities

• Coordinates complex patient care coordination activities. Arranges appointments and follow up as needed, and follows up on completion of applications and pending insurance and benefits referrals.
• Keeps track of patients who have parallel pathways for their medical care and works with clinical providers to take steps at critical points along the continuum. May create and maintain patient lists in Epic for tracking purposes.
• Schedules specialty appointments using scheduling software while ensuring accuracy of exam types, location specifications, and insurance restrictions.
• Identifies referral issues and reports out to management team with suggested solutions.

• Develops and reviews reports related to referral management, tracking, and updating management team with ongoing outgoing and incoming referral issues as they arise.

Moderate Complex Administrative and Patient Care Coordination Responsibilities

• Has foundational understanding of clinical symptoms and their associated escalation level with a commonsense approach for when it is appropriate to escalate or take action to speed along a process within the practice or to obtain immediate clinical intervention.

• Provides advanced customer service when working with patients who may exhibit challenging behaviors. This includes understanding how to deescalate a difficult encounter and also when to seek additional support from leadership and to protect the safety of the work environment.

10%

Advanced General Performance

• Facilitates and provides float coverage as needed for practice, including supporting covering staff with coverage of assignment, and develops and maintains competency in executing functions of access team at all levels.

• Participates in working groups related to assigned area of responsibilities and may suggest and lead improvement projects.

Moderate Complex General Performance

• Maintains provider schedules.
• Acts as the primary coordinator for access for patients initiating care with practice and those transitioning to other practices.

• Provides individualized and team support for new hires and new initiatives and procedures

10%

Lead role duties

• Addresses and resolves escalated issues of day-to-day operations related to assigned area of responsibilities.
• Serves as a liaison to management to advise on, take lead action on, and provide direction on process improvements initiatives.
• Acts as a primary resource for one or more designated functions within department as assigned.
• Supports access team staff through orientation, training, and provides ongoing support related to assigned area of responsibility.
• Attends organizational meetings and trainings to maintain and enhance competencies and skills.
• Works closely with others and is flexible in responding to changing priorities.

• Synthesizes knowledge of practice operations in order to problem-solve, prioritize, and facilitate complex transactions in the course of performing assigned functions.

100%