Care Coordinator - Specialty Services

**Company Overview** Morehouse Community Medical Centers Inc. d/b/a CommuniHealth Services is a dedicated community health center committed to providing comprehensive medical, dental, and behavioral health services to diverse populations. We focus on serving low\-income, uninsured, underinsured, and vulnerable communities with compassion and excellence. POSITION DESCRIPTION: Responsible for the overall coordination of care for patients referred to CHS specialty services. Care Coordinators work with affiliated agencies, such as counselors or other medical facilities, and act as advocates between patients and other medical facilities; helps to ensure patients understand every aspect of their care while also working and making decisions that are in the best interest of the patients. This position requires compliance with CHS written standards, including the Compliance Plan and policies and procedures (including the Code of Conduct), as well as assistance in the continuous monitoring, reporting and corrective action processes of corporate compliance. ESSENTIAL DUTIES AND RESPONSIBILITIES: Every effort has been made to make your job description as complete as possible. However, it in no way states or implies these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude these from the position if the work is similar, related, or is a logical assignment to the position. 1\. Initiates and processes prior authorization requests for specialty appointments in accordance with payer requirements to ensure timely approval and continuity of patient care. 2\. Schedule appointments for specialty services with CHS. 3\. Fax a copy of the finalized provider schedule, along with the demographic sheet, for each scheduled patient, to the designated specialty provider no later than one (1\) week prior to the scheduled appointment date. 4\. Manage incoming and outgoing referrals for Specialty Services. 5\. Verify insurance eligibility and prior authorization requirements, including Medicaid, Medicare, and sliding fee scale prior to appointment date. 6\. Obtain and upload consultation notes, lab results, and procedure reports into the EHR prior to appointment. 7\. Initiates and processes prior authorization requests for specialty appointments in accordance with payer requirements to ensure timely approval and continuity of patient care. 8\. Completes all required infusion authorization and referral documentation and transmits the completed forms to the appropriate infusion clinic in a timely manner to facilitate coordination of care. 9\. Maintains knowledge of Workman’s Compensation procedure. 10\. Travels between CHS locations to provide support to patients and the provider team. 11\. Acts as patient advocate, identifies and develops new community resources and assists with problem solving and documents actions in a patient case. 12\. Works with patients to identify government programs such as Medicaid, WIC, welfare, food stamps, social security disability or unemployment eligibility and documents in a patient case. 13\. Completes annual training as a certified application counselor. 14\. Assist patients with completion of online applications for health insurance and Medicaid. 15\. Acts as patient advocate to link patients with drug manufacturers’ indigent care programs such as 340\-B program, follows\-up on pending prescription assistance applications to ensure patients receive medications timely, and works with patients to timely file renewal applications and refill medication orders. 16\. Collaborates with fellow Care Coordinators and coworkers in a teamwork environment. 17\. Maintains knowledge of and access to Azara DRVS. 18\. Downloads Pre\-visit planning report from Azara, reviews patient charts for accuracy of included information and addition of missing information. Makes notes as appropriate and distribute copies to each team member while hosting the morning huddle at the beginning of each shift. 19\. Maintains an electronic copy of each PVP report, with notes, for a minimum of one year. 20\. Maintains knowledge of the Patient Access job description and fulfills roles as outlined while working as a Patient Access Clerk. 21\. Maintains knowledge of Workman’s Compensation procedure. 22\. Provides outgoing referral appointments to appropriate providers, per policy guidelines, and monitors activities to ensure services are being delivered, meets the needs of patients, and ensures the delivery of services provided meets policy requirements and standardization. 23\. Schedules referral appointments, when applicable, while patient is in clinic, and verbally delivers appointment information to patient. Ensures the delivery of services provided meets policy requirements and standardization. 24\. Provides incoming referral appointments to appropriate CHS providers and monitors activities to ensure services are being delivered and meet the needs of the patients. Share completed encounter notes, per HIPPA policy guidelines, with referring providers. 25\. Maintains knowledge of and access to manual forms and websites for prior authorization (PA) for high tech imaging, medical and behavioral health services. 26\. Completes prior authorizations on high tech imaging, per guidelines, for providers while being the liaison between provider, insurance, and the patient. 27\. Follows up on referrals and orders per policy guidelines. 28\. Follows up with patients transitioning from hospital or emergency room discharge (transition of care TOC), schedules an appointment, request records for provider review. 29\. Receives, sorts and adds appropriate document class and label(s) for incoming medical records to ensure that quality measures are met. 30\. Receives and processes patient requests for Medical Records per policy guidelines 31\. Receives and processes requests for medical records from external sources, including, but not limited to Subpoena’s, attorneys, insurance companies, HEDIS, etc. per policy guidelines. 32\. Maintains a running log of medical records sent to external requestors and the amount each requestor was charged for the medical records. 33\. Maintains current and active list of referral providers and SDOH resources 34\. Maintains compliance with and knowledge of all CHS departmental, facility specific and system\-wide policy and procedures 35\. In addition to the outlined duties above, as a patient\-centered medical home, the incumbent fulfills the principles and theories outlined in organizational policies including assisting navigating patients as needed through the health system making appropriate referrals to case/care management, communicating with the healthcare team to address patient / family caregiver specific needs, etc. 36\. Completes required training per policy, maintains compliance with and knowledge of all CHS departmental, facility specific and system\-wide policy and procedure, attends mandatory departmental meetings and/or training, and follows CHS Mission, Vision and Values in delivery of all services. 37\. Maintains strict confidentiality and adheres to all HIPAA guidelines/regulations as well as compliance with HRSA regulations. 38\. Conducts self in accordance with CHS employee manual, as well as maintains compliance with and knowledge of all CHS departmental, facility specific and system wide policy and procedure. 39\. Participates in all appropriate meetings within the organization. 40\. This position may require work beyond normal working hours. Occasional overtime may be required and/or hours may be shortened as business needs dictate. 41\. Performs all other duties as assigned. **EDUCATION:** 1\. High School diploma or GED 2\. Maintains annual certification as ACA counselor and CAC Medicaid **SKILLS/EXPERIENCE:** 1\. Must be able to read, write, and speak the English language in an understandable manner. 2\. One (1\) year of medical clinic experience. 3\. Ability to establish and maintain effective working relationships with patients, employees and the public. 4\. Ability to perform well\-organized and detail\-oriented work while maintaining privacy in all aspects of the job. 5\. Competence to gather information such as vital signs, weight, changes in medical history including medications, and utilize screenings and interpret results of those screenings during each telehealth appointment. **ENVIRONMENTAL/WORKING CONDITIONS:** 1\. Works in a well\-lighted/ventilated office area of the facility. 2\. Is subject to frequent interruptions. 3\. Is involved with personnel, patients, visitors, government agencies/personnel, etc., under all conditions/circumstances. 4\. Is subject to hostile and emotionally upset personnel, patients, visitors, etc. 5\. Is willing to work beyond normal working hours: weekends, holidays, and other shifts/positions as necessary. 6\. Attends and participates in continuing educational programs designed to keep you abreast of changes in your profession. 7\. Is subject to cuts, bruises, falls, burns from equipment, odors, etc., throughout the workday. 8\. May be exposed to blood borne pathogens, infectious waste, diseases, conditions, etc., including the potential exposure to the AIDS and Hepatitis B viruses. 9\. Occasional overtime may be required and/or hours may be shortened as business needs dictate. **PHYSICAL DEMANDS:** 1\. Must be able to handle occasional lifting and pulling. 2\. Must be able to move intermittently throughout the workday to other sites, if needed. 3\. Must be able to function independently, have personal integrity, and the ability to work effectively with patients, personnel, and support agencies. 4\. Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times hostile people within the facility. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills and working conditions may change as needs evolve. **CommuniHealth Services is an Equal Opportunity Employer.** Job Type: Full\-time Pay: From $14\.00 per hour Benefits: * 403(b) matching * AD\&D insurance * Dental insurance * Disability insurance * Health insurance * Health savings account * Life insurance * Opportunities for advancement * Paid sick time * Paid time off * Professional development assistance * Referral program * Retirement plan * Vision insurance Work Location: In person