Job Description

Job Title: Associate Patient Care Coordinator

Location: Tampa, FL

Contract: 3 months + possible contract extensions

Shift Timing: Mon- Fri 8am-5pm 1 hour lunch. Can be flexible on work hours between 8am-6pm.

Description:

Responsibilities:

• Processing Referrals for patients, obtaining authorizations from the Health Plan, contacting, and coordinating Specialists and patients to set up appointments.

Skills: Healthcare EMR experience needed. Some understanding of the patient referral process helpful but not required, we are willing to train.

Job Function Description

• Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team.
• Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring
• members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification, and census roles.

General Job Profile

- Moderate work experience within own function.

- Some work is completed without established procedures.

- Basic tasks are completed without review by others.

- Supervision/guidance is required for higher level tasks.

Job Scope and Guidelines

- Applies knowledge/skills to activities that often vary from day to day.

- Demonstrates a moderate level of knowledge and skills in own function.

- Requires little assistance with standard and non-standard requests.

- Solves routine problems on own.

- Works with supervisor to solve more complex problems.

- Prioritizes and organizes own work to meet agreed upon deadlines.

- Works with others as part of a team.

Minimum Educational Background

- High school education or equivalent experience.

Functional Competency & Description Proficiency Level

-Access claims information

-Review and interpret call history documentation (e.g., case notes)

-Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)

-Take calls and questions from members and/or providers regarding case status

-Determine whether authorizations are required for requested medical services

-Reference automated job aid tools via computer to research relevant rules, regulations, or procedures

-Learn computer system and process changes and updates and incorporate into daily work

-Contact internal resources if necessary to clarify information

-Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests

CLA_Process Medical/Behavioral/Clinical Services or Benefits Requests C) Fully Proficient

-Provide/explain benefit information to members/providers

-Provide/explain authorization information to members/providers

-Communicate with clinical team to ensure provider receives a response when necessary

-Document call history information into relevant computer system

-Enter medical request data into relevant computer system

-Follow standard procedures to complete requests

-Request medical review via relevant computer system as needed

-Review and advise member/provider of status of a request (e.g., notification, authorization)

-Schedule appointments for members based on request

-Provide information regarding appointments and medical services to facilities staff to assist members

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