Health Plan Coordinator - Rehab

POSITION SUMMARY

Pay Range: $22.64/hr. to $31.22/hr.

Responsible for implementing and coordinating procedures and functions related to patient admission, billing, and insurance authorization in the Outpatient Rehabilitation Services Departments.

KEY RESPONSIBILITIES

Performed majority of the time:

·         Maintains tracking and follow-through of forms for commercial, workers compensation and MVA for Physical Therapy, Occupational Therapy and Speech Language Pathology.

·         Obtains prior authorization for insurances that require prior to services rendered.

·         Schedules patients accordingly to insurance authorization and therapist recommendations.

·         Acts as a back-up for receptionists (scheduling, answering and routing incoming phone calls, providing scheduling guidance to CARS staff.)

·         Provides daily reporting via Box document (ambulatory clinics.)

·         Monitors rehab work queue (clinic appropriate) in EPIC and checks for insurance follow up and authorization submission.

·         Monitors and tracks insurance authorizations via specific insurance excel documents in Box (i.e. Workers Comp, Medicaid, Evicore…etc.)

·         Verifies insurance benefits and eligibility for all new patients prior to treatment.

·         Monitors, tracks and calculates Medicare therapy cap.

·         Reviews following day rehab schedule to ensure that all scheduled appointments have a valid therapy referral attached to the patient appointment.

·         Verifies completion of referral process for patient with insurance plans requiring referral by PCP prior to services.

·         Copies workers compensation chart notes and forwards to workers compensation adjuster(s) within 7 days of the evaluation/ progress note.

·         Creates and maintains PT/OT/SLP charts.

·         Requests chart notes or diagnostic reports from referring doctors before patient’s appointment as indicated per referral.

·         Stays abreast of insurance updates/changes (attends webinars, meetings and receives e-mail updates.)

·         Communicates with therapists regarding prior authorization workflow process and when to submit for more authorization.

·         Communicates with referring MD office to submit prior authorization to insurance when required for therapy prior to the therapy appointment.

·         Communicates with Patient Accounting to submit notification to insurance for start of therapy.

·         Communicates with Patient Accounting when to re-bill for therapy visits.

·         Submits retro authorization requests to insurances where appropriate.

·         Submits insurance appeal correspondence to Patient Accounting where appropriate.

·         Opening reception duties which include: preparing copay collection envelope / locked money bag for courier pick up, unlocking clinic front door, turning on lights in gym and front office, checking voicemail messages.

·         Updates therapists scheduling templates.

Performed occasionally but critical to successful performance of the job:

·         Attends monthly full clinic/staff meeting.

·         Participates in quality improvement for increasing patient satisfaction with department services.

JOB SPECIFICATIONS

Education:

Required

·         N/A

Preferred

·         Associate degree in Business or related field. 

Experience:

Required

·         N/A

Preferred

·         Two (2) years’ experience in medical office or insurance billing.

Licenses, Certifications and/or Registrations:

Required

·         N/A

Preferred

·         N/A

Job Related Skills, Abilities and Behaviors:

Required

·         Professional appearance and personal conduct for the employee's particular job.

·         Uses effective communication skills taking into consideration body language, filters, listening, paraphrasing, and questions with customers of diverse ethnic and cultural backgrounds.

·         Excellent customer service and interpersonal skills.

·         Ability to work independently with efficiency and confidence.

·         Excellent telephone, written and verbal communication skills.

·         Experience in working with multiple tasks with many interruptions.

·         Organization skills and ability to prioritize duties to meet deadlines.

·         Ability to type 50wpm preferred.

·         Ability to develop skills in the use of computerized hospital information/ordering system - “order communications.”

·         Demonstrates ability to problem solve.

·         Prioritizes daily tasks to be completed while providing necessary reception support.

·         Provides efficient link between staff and customers to ensure proper procedures are completed.

·         Demonstrates ability to receive feedback or seek guidance when appropriate.

Preferred

·         Bilingual skills in English/Spanish.

·         Moderate level computer knowledge and skills with proficiency in Word and Excel.

·         Experience with medical terminology, insurance referrals and authorizations.

Additional Posting Information

Hillsboro Medical Center believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.