Health Services Coordination Specialist

Overview

The Health Services Coordinator Specialist reports to the Navigation Center Healthcare Services - Supervisor at the Central Health Navigation Center. The Health Services Coordinator - Specialist will provide primary referral management support within the Navigation Center call center for services to be performed by a Central Health Network provider. This position may also provide referral management support for incoming referrals for Central Health services. The Health Services Coordinator - Specialist will perform a wide range of administrative duties including referral processing, patient registration, verification of benefits, insurance authorizations, patient appointment scheduling, referral process education to patients, verification of medical information, and communication with referral sources and other tasks assigned.

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

Responsibilities

• An estimated 80% of staff time is dedicated to receiving incoming calls via the incoming call queue or performing outbound calls to initiate contact on behalf of Central Health after receiving a specialty services referral for a contracted network partner (This will also include making appointments on the behalf of patients, and confirming appointment adherence with contracted network services).
• An estimated 20% of staff time is dedicated to off-phone activities, which may include administrative duties such as scanning and organizing electronic documents, delegating and organizing electronic fax records, preparing mail correspondence to patients, and supporting data entry for pre-registration activities.
• 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/compliment process via the incident management system.
• Navigate and utilize multiple healthcare software platforms or EHRs to schedule specialty appointments, imaging or diagnostics 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 patients who qualify for appointments with Central Health Contracted Network Partners.
• 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).
• Management of assigned referral work queues designated for incoming and outgoing network specialty services consults, and management of inbound electronic fax lines for receiving and processing referrals and relevant health information.
• 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 imaging and diagnostic orders placed by Central Health providers. Secure, document and transmit any information related to third party authorization for outbound referrals or orders for diagnostics or imaging.
• 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 knowledge of healthcare systems navigation pertaining to the coordination of specialty services, labs, imaging, and diagnostic services.
• Demonstrates ability to problem-solve and make decisions to achieve high levels of streamlined operational processes.

Qualifications

Education:

• High School Diploma or equivalent required.

Experience:

• 3 years of previous direct healthcare, medical office and/or healthcare call center experience required.
• 1 year of previous scheduling, registration, referrals, and/or billing experience required.

Licenses and Certifications:

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