Lead Health Services Coordinator

Overview The Health Services Coordinator - Lead reports to the Navigation Center Healthcare Services Supervisor at the Central Health Navigation Center. The Health Services Coordinator - Lead will provide primary referral management support within the Navigation Center call center for all procedures or surgeries performed by a Central Health provider at a contracted Central Health network facility. The scope of work also includes diagnostic/imaging and complex radiological services to be performed at a contracted Central Health Network provider facility. This position may also provide referral management support for incoming referrals for Central Health services or referrals to contracted Central Health network providers providing access to specialty services. The Health Services Coordinator - Lead is responsible for management of assigned work queues for outgoing referrals and serves as the initial point of contact for imaging, diagnostics, and surgery/procedure scheduling.

This position will work at least 50% of their hours on site in the Navigation Center.

Responsibilities

An estimated 60% of staff time is dedicated to performing outgoing calls to patients, providers, imaging/diagnostic centers, sleep study centers, and ambulatory surgery centers to secure appointments for ordered services.

Supporting inbound calls by serving as the primary contact point for contracted Central Health network scheduling or registration.

An estimated 40% of staff time is dedicated to off-phone activities which include administrative duties pertaining to the coordination of imaging, diagnostic, procedural authorization, surgical clearance, scheduling, and registration.

Management of outbound referral work queues designated for diagnostics, imaging, or procedural orders, and secondary management of assigned referral work queues designated for incoming and outgoing network specialty services consults.

Routing Outbound Referral Orders received to applicable ASC Work Queues for enhanced Revenue Cycle processing.

Initiating and coordinating completion of surgical forms, submitting surgical forms via Fax to Central Health Contracted Network Partner Facilities prior to scheduling patient appointment, receiving Inbound results and/or records pertaining to a patient/member’s Diagnostics/Surgery/Procedure, resulting received information into patient/member charts and releasing to provider via Epic.

Resolve patient inquiries as directed including but not limited to MyChart Support, Member benefits, basic clinic information, payment processing, patient financial responsibility, and initiation of the MAP/MAP Basic Member or Central Health Patient complaint/complement process via the incident management system.

Navigate and utilize multiple healthcare software platforms or EHRs to schedule patient procedures at contracted network facilities outside of Central Health, request or receive patient records, and communicate with contracted network partner staff to ensure a seamless healthcare experience for the patient.

Directly book transportation services for qualifying patients to/from diagnostic/imaging/procedural appointments.

Provide exceptional customer service to all patients, including but not limited to, scheduling and confirming appointments using multiline phones and performing data entry into the EHR system while maintaining strict confidentiality of personal health information (PHI).

Sending outbound faxes to Central Health Contracted Network Partners to facilitate access for Central Health patients or member and processing time sensitive documents (inbound and/or outbound) for services provided by a Central Health Contracted Network Partner.

Complete any third party payor pre-authorization processes and requirements for procedure or surgery orders placed by Central Health providers.

Secure, document and transmit any information related to third party authorization for procedures or surgery performed at a Central Health Network Partner facility.

Develops and maintains favorable internal relationships, partnerships with co-workers, including clinical managers, clinical support staff, providers, and business office staff.

Ensures all tasks provided and associated with patient care, patient administrative processes, and related duties comply with all regulatory and accreditation standards and Central Health Policies and Procedures.

Attends staff meetings and education offerings both in person and via teleconference/online as required and Supports organizational initiatives to promote and maintain a strong positive workplace culture.

Successfully meets or exceeds productivity metrics assigned to the position.

Other duties as assigned.

Knowledge, Skills and Abilities

Bilingual (Spanish/English) preferred.

Demonstrates a high level of skill at building relationships and providing excellent customer service.

Strong attention to detail and accuracy.

Has the ability to utilize computers for data entry and information retrieval.

Shows excellent verbal and written communication skills.

Demonstrates knowledge of federal, state, and local insurance regulations.

Demonstrates knowledge of the referral process for a variety of insurance plans.

Demonstrates success in researching and resolving complex issues.

Demonstrates familiarity and proper care of electronic devices common GUIs found within most health care environments (for example, personal computer skills, spreadsheets, word processing, patient record systems, EHR systems, etc.).

Demonstrates ability to problem-solve and make decisions to achieve high levels of streamlined operational processes.

Qualifications Education:

High School Diploma or equivalent required.

Work Experience:

5 years Previous direct healthcare, medical office or healthcare call center experience required.

3 years Previous experience working as a Medical Assistant in a scheduling, registration, referrals, and/or billing environment required.

Licenses and Certifications:

Successful completion of Medical Assistant Certification program (Certified Medical Assistant (CMA)-AAMA) preferred.