Care Coordinator 2
Location Decatur, Georgia, United States of America Category Operations Job Id R0018441
ChenMed is transforming healthcare for seniors. We provide big answers to big problems in health care delivery. ChenMed is a full-risk primary care market leader with an innovative philosophy, unique physician culture and end-to-end customized technology. These things allow us to provide world-class primary care and coordinated care to the most vulnerable population – moderate- to low-income seniors who have complex chronic diseases.
Through our innovative operating model, physician-led culture and empowering technology, we are able to drive key quality and cost outcomes that create value for patients, physicians and the overall health system. Our model allows us to practice medicine the way it should be practiced. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships. Our model also drives and enhances compliance with treatment plans.
As a result of our efforts, our patients realize lower hospital admissions. Their overwhelming response to our approach is reflected in our aggressive, organic growth and net promoter scores in the low to mid 90s, which is unheard of in any industry. Read more about our results and the value of the ChenMed model.
As a company, we are making a difference in the lives of seniors and the health care system overall.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Coordinates patient referrals with specialists and/or hospitals, completes referral requests and transmits medical records and correspondence via mail and/or secured fax or email.
- Trains new Care Coordinators and assists with training on new processes with direction from Referral Manager.
- Manages approval flows and follows up with approvers who do not respond within a 24 hours period.
- Communicates responses to Referral team.
- Provides coverage for Care Coordinators when calls-ins, PTO or unavailable and/or in times of high patient volume.
- Serves as a backup to the Referral Manager when unavailable.
- Assists Care Coordinators on complicated referrals.
- Assists with orders, as needed, per Referral Manager. Coordinates surgical procedures with Tier 1, 2 & 3 providers. Assists Skilled Nursing Facility (SNF) team with follow-up on orders.
- Coordinates and processes patient referrals to completion with precision, detail and accuracy.
Definition of completion:
- Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.
- Orders have been approved (when needed).
- Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.
- Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).
- Completes orders with proper documentation on where patient is scheduled and how patient was notified.
- Referrals have been sent to specialist office & confirmed receipt.
- Provides extraordinary customer service to all internal and external customers, including, but not limited to: patients colleagues, physicians, etc. at all times. Establishes and maintains relationships with service providers and clinicians.
- Ensures assigned tasks are completed precisely and accurately.
- Ensures Preferred Provider List is used accurately and effectively. Collaborates with referral management to ensure specialist network is adequate for the geography and escalates accordingly when network adequacy impacts access to care.
- Performs other related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of medical terminology, CPT, HCPCS and ICD coding preferred
- An inept understanding of the company's patient population, including the complexities of Medicare programs to patients in the current healthcare marketplace
- Detail-oriented with the ability to multi-task. Must be open to cross-functionally training in referrals and back office duties
- Able to exercise proper phone etiquette with the ability to navigate proficiently through computer software systems
- Team-oriented with the ability to work extremely well with patients, colleagues, physicians and other personnel in a professional and courteous manner
- Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks
- Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software
- Ability and willingness to travel locally within the market up to 10% of the time
- Spoken and written fluency in English; Bilingual a plus
At ChenMed, If you are an innovative, entrepreneurial minded, over-achiever who is extremely passionate in helping people and revolutionizing Healthcare again, we are that dynamic and exciting company you are looking for!
After applying, we encourage you to "follow" us on LinkedIn (ChenMed) as well! This way you can stay informed and up to date on what’s happening around our organization and start your path to becoming part of our FAMILY!
EDUCATION AND EXPERIENCE CRITERIA:
- High School diploma or equivalent required
- Associate's degree preferred
- A minimum of 2 years of hands-on healthcare experience in a clinical setting required
- Experience with Web IVRs and obtaining referrals/authorizations for multiple payors strongly preferred
- Healthcare experience within the Medicare HMO population is a plus
- A valid, active driver's license in State of employment is required; position may require travel within the market
- Medical Assistant certification preferred
- CPR for Healthcare Providers is preferred
The Care Coordinator 2 is a highly visible customer service and patient-focused role. The incumbent in this role works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel to ensure the referral process runs smoothly. He/She operates in a dynamic and professional environment to ensure the highest level of quality healthcare is delivered to our members.
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Life at ChenMed
Meet Our Team
David Guerra MD, Medical Director