Patient Care Coordinator - FT - Days - Bariatrics

DHR Health - US:TX:Edinburg - Days

Summary

FLSA STATUS: ☐ Exempt ☒ Non-Exempt

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY

The primary purpose of the Bariatric Patient Care Coordinator is to help the patient navigate and educate the patient and family on the DHR Health system to obtain all information necessary prior to their surgery, regarding their treatment and diagnosis. The Patient Care Coordinator is responsible for the following: Meeting with the patient and explaining their surgery orders and referrals while determining insurance eligibility, financial status and eligibility by verifying insurance information via phone or on line; calling third party payers to obtain benefits to include effective dates of coverage, pre-existing condition clauses, in and out of network benefits and maximum coverage. Responsible for scheduling pre-surgical testing needed, in-office and/or in-hospital procedures, making sure necessary authorizations have been obtained, and data entry into the facility computer systems.

POSITION EDUCATION/ QUALIFICATIONS­

• High School graduate/GED certificate or equivalent is required
• Bachelor’s Degree or course work toward a Bachelor’s preferred
• Ability to read, write and speak English, bi-lingual in Spanish, and able to communicate effectively in both English and Spanish preferred

JOB KNOWLEDGE/EXPERIENCE­

• Previous healthcare experience (2 yrs.) is required, physician or hospital experience preferred.
• Good working knowledge of insurance benefits and medical terminology required
• Knowledge of Microsoft Office suite, working knowledge of Excel required be able to type at least 35 WPM
• Previous experience working with interdisciplinary teams preferred
• Good organizational skills, written, verbal communication and excellent customer service skills are necessary
• Professionalism, good demeanor, presentation and the ability to communicate clearly and concisely with all levels of management, administration, and physicians
• Ability to schedule surgeries, for both in-hospital and in-office procedures
• Schedule, coordinate and monitor appointments of patients for pre-surgical diagnostic testing
• Ability to identify the appropriate coordination of benefits for insurance carrier
• Good overall clerical skills, ability to work productively and effectively
• ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
• Requires reasoning ability, good independent judgment and the ability to work with frequent interruptions

Responsibilities

• POSITION RESPONSIBILITIES:
• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Initiates communication with patient upon receiving a referral of a patient for surgery and outlines needs and identifies resources to meet those needs for each patient and ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures
• Promote supportive relationships with the patient and family, to help navigate all needed documents prior to surgery
• Provides patients and families with education, and decision making support related to the impact of medical illness, social needs, functional needs, or financial needs on healing and recovery
• Initiates, facilitates and works with internal and external resources as to meet the identified patient needs
• Obtains orders from the physician for the individual patient, continues to follow up with patient and PCP to ensure all pre-surgery appointments are attended in order to obtain “ medical clearance” for surgical procedure and acts as a liaison between physician, hospital, OP diagnostic areas, the office and the patient and his family previous to surgery
• Schedule, coordinate and monitor EGDs
• Demonstrates proficiency of personal computers and Microsoft Office applications and other software as required.
• Appropriately monitor and verify benefits (deductibles, co-pays, coordination of benefits and co-insurance) for all accounts on the daily office visit schedule and pre-admission roster for the next day’s services.
• Ability to reference ICD-10-CM, CPT from doctor’s order to insurance carrier for eligibility and coverage of procedure
• Utilizes phone or on-line verification systems, i.e. TMHP, Availity, Data Link, internal system, etc., for insurance eligibility and benefits.
• Ability to determine timely filing deadline for all insurance carriers and identify the appropriate coordination of benefits for insurance carrier.
• Determines financial status and refers patient for financial screening as appropriate if patient does not have insurance coverage and needs financing options.
• Ensures referral/pre-authorization/pre-certification requirements have been met
• Has appropriate follow up and contact with hospital or patient if necessary
• Understand and adhere to managed care policies and procedures
• Answer and direct all phone calls appropriately
• Adheres to assigned projects/tasks, and volunteers for special assignments/projects
• Scans information into the EMR as needed
• Other duties as assigned

Other information:

LINES OF REPSONSIBILITES :

(Chain-of-command)

• Practice Manager → 2. Administrator → 3. Chief Ambulatory Officer

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC :

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.