Patient Care Coordinator

• Responsible for the coordination of appointments and support services for departments/physicians
• Interface with insurance companies and other payors on prior authorization and referral requests
• Abstract charts and assign CPT, ICD-9 and HCPCS codes for purposes of obtaining prior authorization
• Assist billing personnel with preparation of denials and submitting appeals for payment
• Assist in resolving patient problems, concerns and complaints
• serve as patient advocate and liaison
• Ensure adherence to Hospitals and department policies and procedures
• PATIENT CARE - Assist patients in locating departments
• schedule and coordinate patient appointments
• refer patients and families to appropriate services and resources
• PRIOR AUTHORIZATION - Complete pre-screening process for specialty clinic appointments for referral and/or prior auth
• Verify coverage eligibility on patients needing prior authorization
• CODING - Abstract chart information and assign CPT, ICD, and HCPCS codes for purpose of predetermination or prior authorization
• LIAISON - Perform as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/ coverage and prior authorizations
• DOCUMENTATION - Complete and fax paperwork and pertinent medical documentation to insurance companies and other payors for approval
• document final prior authorization in financial systems
• FINANCIAL ASSISTANCE - Refer self-pay patients for financial assistance
• make financial assistance appointments
• COORDINATION - Coordinate with hospital and clinic surgical representatives, providers, and other applicable areas for day surgery prior authorization and/or financial coverage or assistance
• TRAINING - Perform outreach/training with clinical areas to ensure process flow remains tight and to maintain open communication
• DENIALS - Track and investigate payment denials due to "no authorization"
• report detail information to supervisors and work with billing office representatives to coordinate appeal efforts
• CUSTOMER SERVICE - Identify Primary Care Physicians for all patients and communicate with the PCP as necessary
• take messages for department personnel
• Acquire prior patient records, patient billing, referral information and lab results
• Assist referring providers in resolving problems, locate UNM physicians and forward documents
• PATIENT CARE - May assist clinical staff with routine non-invasive patient treatment procedures and initial screenings
• LEAD - May exercise functional and technical lead over lower level staff
• PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols
• PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
• PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
• PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner
• PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"

• High School or GED Equivalent
• 2 years directly related experience
• Medical Terminology Course w/in Six Months of Position (nonessential)
• Bilingual English, Spanish, Keres, Tewa, Tiwa, Towa, Zuni, or Navajo (nonessential)

Bilingual English, Spanish, Keres, Tewa, Tiwa, Towa, Zuni, or Navajo