Practice Coordinator 2

New Patient Scheduling and Processing                  %

• On a daily basis reviews and works referral workqueues documenting activities within the referral record.

• Acts as the primary contact for referring physicians and new patients

• If practice utilizes a mirror system for external referrals, such as an electronic log, maintains electronic log but also creates referral record for accurate tracking and documenting of external referrals.

• Assigns new patients to providers as required, taking into account scheduling issues.

• Schedules and registers patients by telephone or in person before first appointment meeting established accuracy and performance standards. Completes appropriate practice intake paperwork and follows established practice guidelines to ensure new patients are seen within prescribed time lines. Communicates any problems with the schedule with supervisor.

• Collects and verifies insurance and referral/authorization information for first appointment ensuring referral records and Hospital Accounts Records (HARS) are created and assigned to the appointment.

• Schedules and coordinates any pre-appointment tests or appointments.

• Explains first appointment procedures in layman’s terminology to patient including required records, pathology slides and radiology films to bring or send prior to the first visit; prepares and mails New Patient Packet or sends through MyChart; provides other information requested by patient.

• Gives directions and instructions to patients before the first appointment. Manages patient expectations by providing practice-specific guidelines related to service/visit. Seeks clinical input when appropriate.

• Creates a professional and positive first impression for patients and referring physicians. Demonstrates good judgment and common sense.

Advanced New Patient Scheduling and Coordination 35%

• Secures outside medical records, CD’s of scans and pathology slides; reviewing them for completeness; and making a determination as to which physician can best evaluate the patient.

• Understands and is able to prioritize new patient scheduling based on diagnosis and current treatment status to ensure complex patients are scheduled according to practice priorities (e.g. someone newly diagnosed with Stage IV colorectal cancer is seen within the week vs. a second opinion currently receiving treatment is seen within 3 weeks).

• Informs patients about possible treatment scheduling options, clinical trials and screening is coordinated with appropriate research personnel and the appropriate physician. As indicated upon screening, if the patient would benefit from a consultation with other clinical disciplines consults with the appropriate department and will work to coordinate care, to optimize schedules, and expedite services.

• At new patient visits, as appropriate meets with patient after the visit to explain how care is coordinated with possible clinical trials, testing, surgical procedures and care within other departments (e.g. general surgery, cardiology) and with other external providers.

Surgery Scheduling      %

• Coordinates scheduling of all outpatient and inpatient surgeries for the surgical practice. Ensures that all surgical procedures are scheduled within a clinically appropriate time frame. Interfaces with patients, physicians and hospital staff to ensure adequate communication regarding all aspects of surgical services.

• Interacts with clinical and academic staff to coordinate surgical activities with physician’s other responsibilities. Processes complex hospital admission forms, schedules pre-surgical tests and appointments, and secures all necessary resources and equipment for surgery.

• Manages complex scheduling coordination related to securing OR time outside of designated block time in the operating rooms. Works to maximize both OR and surgical robots utilization as well as complex joint cases with one or more additional surgeons or other services.

Advanced Surgery Scheduling 20%

• Coordinates pre-operative anesthesia appointments with other testing, authorization coding and scheduling the surgery in Op-Time. Additionally many cases require complex admission, discharge and planning coordination involving hospital reservations and authorizations related to study patients on protocol, transfers from outside hospitals and post transfer urgent authorizations and surgical planning.

• Works with patients and staff to confirm availability and accuracy of medical information within APeX and to ensure compliance with all hospital policies and procedures.

• Secures authorization for surgical procedures and coordinates with Hospital Admissions Department as needed. Communicates with the surgeon post-surgery to confirm if any additional surgical procedure was performed and if so to follow up with the insurance company immediately to amend the authorization. Acts as primary liaison to procedure billing team to coordinate updated authorizations and or TARs for mid procedure changes or additions.

• Ensures compliance with Medical Center bylaws and Regulations ensuring the diagnosis is confirmed before treatment is offered through formal review of any and all outside studies and pathology. The coordinator is the sole person to ensure appropriate and timely communication and documentation with the patient and the physician.

• Successfully interacts with patients to secure surgical consent for cosmetic services. This includes identification of cases, cosmetic price guidelines, quote prices and coordinate payment. Analyze the pricing structure to ensure that the prices remain competitive and are updated as needed. This position is expected to represent UCSF Medical Center’s objective to grow elective cosmetic services by providing sophisticated customer service and sales
   

• Arranging post-surgical appointments and testing, which may or may not include Home Care, Physical Therapy, starting paperwork for durable medical equipment and following up on all other paper work, i.e. Workers Compensation as necessary

Revenue Cycle       %

• Performs cash collection and depositing functions as assigned, complying with all established policies and procedures.

• Communicates Medical Center administrative and financial policies clearly to patients, answering patient account questions and knowing when to refer patients to financial counseling, billing agents, patient relations or other support departments for additional help.

• Obtains and documents insurance authorizations for established patient visits, referrals and procedures or ancillary services. Communicates clinical information from medical records authorization requests to insurance companies.

• Demonstrates competency working with CPT codes and ICD-9 and ICD-10 for the purpose of scheduling and securing authorization.

• Works with patients and staff to confirm availability and accuracy of medical information within APeX and to ensure compliance with all hospital policies and procedures.

Moderate Complex Revenue Cycle 5%

• Monitors provider(s) open charts and encounters and works with providers to complete encounter documentation in a timely manner to support revenue cycle workflow. May assist provider with instructions on how to close encounters opened in error.

• Works RFI workqueues to secure information for accurate billing submissions or to respond to denials such as retro authorizations, clinical documentation, and addended authorizations with add on CPT codes.

• Secures authorization for procedures, specialty visits and ancillary testing and coordinates with Hospital Admissions Department as needed.

• Provide assistance with complex DME authorizations that often require precise documentation in specific formats to receive approval

• Provide assistance with medication authorization for new medications and refills.

Advanced Revenue Cycle       %

• Secures complex insurance authorizations for services, medications, or testing and is able to track the authorizations for renewal based on insurance company driven limits of time frames or numbers of visits or services.

• Has demonstrated competency working with HCPC codes and is able to look up and locate the appropriate codes for the purpose of requesting authorization (e.g. J codes for medications like chemotherapy).

• Understands how to identify and interpret a patient’s insurance benefit package, including pharmacy and mental health carve outs. Utilizes this information to direct authorization requests and to coordinate these services for patients.

• Reviews & analyses monthly denial reports for both professional and hospital billing. Initiatives retro authorizations from denial report.

• Identifies trends in denials and works with practice team and supervisors to develop and implement improved workflows to minimize denials.

• Compiles & analyzes data for reports to track basic revenue cycle measurements such as charges, payments, visit volume, etc. and creates reports in Microsoft Excel.

• Oversees and coaches staff on complex authorization requests as they arise.

• Address patient complaints from patients regarding billing and complaints related to billing that come out of Patient Relations.

• Through reporting track patterns of billing complaints and identify patterns which can be addressed with coaching and education of staff and providers.

• Understands the concept of managed care and is knowledgeable about the resources available to the staff in regards to knowing the specific requirements of individual managed care plans. Assists patients to understand the concept of managed care.

• Reviews all upcoming visits to determine patient eligibility and assists with transitioning patients who are no longer eligible to new primary care practices through collaboration with the practice Social Worker and clinical teams.

• Department resource for insurance questions and insurance updates, including having reserved time on the staff agenda to review updates with administrative team, include important updates in the practice newsletter including drafting newsletter announcements

• As practice SuperUser will produce reports and review with staff cash collection barriers to improve cash collection rates for the practice.

Check in / Front Desk:   %

• Greets and welcomes patients making eye contact and utilizing AIDET standards.

• Determines a patient’s co-pay obligation and collects it at the time of the visit; may also collect payments on patient accounts.

• Gives priority to the timely registration of patients on check-in and is aware of the necessity of maintaining practice flow, paying careful attention to the performance improvement initiatives to reduce delays.

• Communicates with patients in a confidential professional manner using tact and diplomacy.

• Monitors and maintains the reception area, making sure it is tidy and there is adequate availability of reading and educational materials. Ensures that the temperature of the reception area is comfortable and that there is adequate and appropriate seating for all patients.

• Observes the waiting area and performs customer service intervention when patients have been waiting a long time or are not receiving adequate service

• Assists patients with use of Kiosk and actively works to promote Kiosk utilization

Advanced Check in/ Front Desk:           %

• Responsible for front end office responsibilities to include but not limited to functions ranging from registration and front desk duties, referral processing, authorization coordination and review, cash deposits, DME oversight and scheduling functions. They/Them will also act as a Care Support Assistant for the Delivery System Reform Incentive Payment (DSRIP) funded clinical team.

• Develops and analyzes front desk productivity reports in partnership with the management team to improve co-pay collection rates and accurate payer plan capture. Identifies opportunities for productivity improvement and assists management team with staff coaching and workflow enhancement.

• Is primarily responsible for representing the clerical team as the public face and works closely with the administrative and management teams to support practice operations and customer service recovery and intervention efforts. They/Them provides support to all functions of the administrative teams to include: message boards, referrals, Apex in-baskets, scanning and filing.

Cadence Template Builder           %

• Able to create Cadence schedule templates for providers

• Understands how template construction effects access and works to ensure templates is user friendly and help promote consistent clinic access.

• Able to generate reschedule reports in Cadence and work with other members of administrative team to ensure patients are rescheduled in a timely manner to avoid customer service problems.

Administrative and Patient Care Coordination Responsibilities         %

• Schedules established patient appointments using Apex and its related components.

• Understands the distinction of each medical practice and how care is delivered in each setting.

• Coordinates appointments with multiple providers as required.

• Discusses practice policies and procedures with patients and referring physicians.

• Answers questions about provider schedules and acts as a resource to other medical center practices and ancillary service administrative staff.

• Has a keen awareness of the need to provide prompt and convenient appointment access to patients.

• Adheres to the provider productivity standards as established in APEX templates for the practice and schedules appointments with the appropriate appointment type.

• Screens all telephone calls, screening for emergencies and routing all messages, requests for same day appointments, refill requests, etc. to the appropriate box.

• Utilizes legacy systems and Apex to retrieve pertinent patient data.

• Follows practice procedure for follow-up of missed appointments.

• Covers Apex in-baskets and phone messages when other members of the team are absent.

• Demonstrates an ability to adjust priorities as required for smooth operation of the practice and notifies the clinical staff.

• Provides administrative support to providers in coordination of patient care (i.e. sending patient letters, educational materials, results of lab tests, etc.)

• Schedules procedures and tests providing appropriate instructions to patients.

• Collaborates with clinical staff in problem-solving patient needs and requests for same day appointments and other appointments requiring care coordination. Works together with the clinical staff in the processing and follow-through of urgent patient needs.

• Demonstrates courtesy and overt helpfulness in all interactions. Collaborates with Practice Supervisor and Administrative Director in the resolution of patient complaints.

• Assists in maintaining current filing and scanning.

Moderate Complex Administrative and Patient Care Coordination Responsibilities       %

• Must have an understanding of multiple clinical symptoms and their associated escalation level with a common sense approach for when it is appropriate to escalate or take action to speed along a process within the practice or to obtain immediate clinical intervention.

• Advanced customer service skills in working with and providing exceptional customer service to patients who are medication dependent and may exhibit challenging behaviors. This includes understanding how to deescalate a difficult encounter and also when to seek additional support from leadership and to protect the safety of the work environment.

Advanced Administrative and Patient Care Coordination Responsibilities 10 %

• Acts as liaison with Concierge Services. Expedites requested services.

• Coordinates complex patient care coordination activities. Arranging appointments and testing, which may or may not include Tumor block genetic testing, Home Care, Physical Therapy, starting paperwork for durable medical equipment or disability paperwork and following up on all other paper work, i.e. Workers Compensation as necessary.

• Keeps track of patients who have parallel pathways for their medical care and works with clinical providers to take steps at critical points along the continuum. May create and maintain APeX patient lists or Excel Spreadsheets for tracking purposes. For example, patients receiving neo adjavent chemotherapy who will be scheduled for surgery once their tumor has shrunk and must be evaluated by the MD after cycle 3 of their chemotherapy regimen. The PA IV will need to keep track of the patient and schedule a timely appointment with the surgeon and the medical oncologist to coordinate planning for surgery scheduling.

• Is skilled and able to book Radiology appointments directly into Radiology scheduling software while ensuring accuracy of exam types, location specifications and insurance restrictions.

• Identify referral problems; report out to management team with suggested solutions.

• Develop and review reports related to referral management, tracking and updating management team with ongoing outgoing and incoming referral issues as they arise.

• Oversight with maintaining Open Access schedules in order to meet the Patient-Centered Medical Home (PCMH) standards (could include Direct Access scheduling into the generic job template)

APeX and IT Specific Skills 5 %

• Performs the following APEX specific Patient Care Coordinator (PCC) functions as appropriate to completion of APeX PCC training and job duties:

  • Enter new incoming referrals entering authorization information as appropriate

  • Updating and closing CRM messages and converting CRM messages into telephone encounters if practice is serviced by the Ambulatory Services Call Center

• Open, document within, route and close telephone encounters. Able to accurately utilize documentation steps when leaving a telephone encounter open pending further communications with the caller. Able to utilize smart text logic to document patient phone screening as associated with complex appointment scheduling.

  • Works applicable APeX workqueues to address patient care and service matters

  • Create and send administrative communications via MyChart

  • Create SmartPhrase templates associated with administrative functions

  • Create and route patient letters associated with administrative matters

  • Perform enter/edit outside test results following established workflow and steps

  • Open, document within, route and close telephone encounters. Able to accurately utilize documentation steps with leaving a telephone encounter open pending further communications with the caller. Able to utilize smart text logic to document patient phone screening as associated with complex appointment scheduling.

  • Works applicable APeX workqueues to address patient care and service matters

  • Encourage use of the check in kiosk and trouble shoot technical or customer service issues

Moderate Complex APeX and IT Specific Skills                                                                                                  %

• Modify order class of labs from lab collection vs. clinic collection or UCSF Collect vs. External Collect.

  • Perform advanced appointment scheduling using complex scheduling protocols from a variety of ancillary and subspecialty services some of which will require authorization.

  • Support Patient-Centered Medical Home, Standard 1 guidelines that require patients have daily available appointment access to the practice and if no appointments are available coordinate them at another site or within Adult or Pediatric Urgent Care.

Phone Bank 10%

• Responds to telephone calls from patients seeking medical care at UCSF Medical Center.

• Utilizes the EPIC Appointment Scheduling System (Cadence) to schedule patient appointments in accordance with practice policy.

• Documents call information in the EPIC CRM in a concise, accurate manner.

• Is able to convert CRM messages to telephone encounters according to practice guidelines and workflows

• Responds to patient’s online Web appointment requests for patients utilizing the online appointment system.

• Utilizes Phone Bank protocols to determine when to involve a clinician on a call due to urgent or emergent symptomatology.
   

General Performance 5%

• As assigned, pulls and prepares charts prior to patient appointment following established practice criteria.

• Files all patient related information, tracks incoming slides, films and reports as required by practice; returns materials to referring physicians in a timely manner utilizing tracking systems.

• Scans and imports patient records and documents in APeX system following established guidelines and policies.

• Upholds UCSF Medical Center policy regarding the maintenance and confidentiality of medical records and other patient information. Maintains and adheres to patient confidentiality and HIPAA guidelines including the distribution of NOPPs (Notice of Privacy Practices).

• Participates in team building by actively contributing during meetings and with staff and providers in discussion of all practice activities.

• Attends training classes provided by Medical Center, Billing Agent, and others as necessary. Bring information back to practice and use on the job.

• Works with supervisor and co-workers to ensure that the practice responds comprehensively to patient care needs through improved procedures and administrative systems. Is an active participant in performance improvement projects and customer service initiatives.

• Complies with all Medical Center and Ambulatory Services procedures for infection control, safety, administrative and clinical practice. Complies with activities mandated by Joint Commission, Title 22.

• As assigned, fills in for other co-workers to help address work load problems and cover vacation or sick leave openings.

Moderate Complex General Performance    %

• Maintains provider calendars

• When working in a primary care practice, assists with the delivery and maintenance of a high standard of patient care using the Patient Centered Medical Home model which emphasizes the care of the “whole patient” which includes in-reach, outreach and intensive follow up on referrals.

• When working within the primary care environment acts as the coordinator for all of patient’s needs such as forms (ie. work release, disability, immunization records, etc.) and is principally responsible for the continuity of care for patients which includes a significant amount of support for patients at the time of the visit and between visits.

• Provides 1:1 and team training for new hires and new initiatives and procedures

Advanced General Performance     %

• Facilitates Float coverage as needed for practice (e.g. when float is assigned, work with float to ensure successful coverage of work)

• Serves on and contributes documentation to the Patient Centered Medical Home application workgroup

Environmental Responsibilities:   %

• Reports any malfunctioning of equipment.

• Complies with recommendations made by ergonomic specialists to avoid workplace injury

• Complies with infection control policies related (e.g. does not eat at the front desk or in patient care areas)

Moderate Complex Environmental Responsibilities 5%

• Serves as practice deputy for life / safety activities helps lead drills

Customer Service Outreach     %

• Deals directly with patients either by telephone, electronically or face to face while consistently following EVERYDAY PRIDE principles in verbal and written communications

• Responds promptly and courteously to internal and external inquiries. Stays logged into appropriate APeX Pools and In Baskets.

• Handles front line patient complaints with the support of the Practice Supervisor / Administrative Director

• Supports all performance improvement initiatives as outlined by the Medical Center leadership through active participation and initiation

• Obtains and evaluates all relevant information to handle inquiries and complaints

• They/Them is a strong team player, has a dedicated work ethic, and is willing to learn and adapt to new tasks when asked. They/Them is comfortable building rapport with patients quickly and is able to work effectively with and without supervision and remain calm and friendly in all interactions with patients

• Notifies providers of patient delays and service issues. Acts and advocate for patients to help facilitate provider punctuality in seeing patients according to schedule.

• Communicates provider delays with front office team and makes regular announcements to waiting room as needed when delays are over 30 minutes.

• Offers suggestions for change or improvement in clinic/practice operations.

• They/Them leads by example in the areas professional appearance, demeanor and body language, making eye contact with patients and internal customers, exhibits a friendly demeanor to put patients at ease.

• Seeks opportunities to improve patient convenience. Utilizes service recovery amenities as appropriate. Contributes to the development of a patient-focused environment.

Lead role duties 5%

• Addresses and resolves escalated issues of day to day operations (e.g. customer service, provider complaints, cross departmental communication or coordination problems, etc.)

• Serves as a liaison to management to advise on, take lead action on, and provide direction on process improvements initiatives

• Acts as a primary resource for one or more designated functions in the department (e.g., APeX SuperUser)

• Provides feedback related to staff performance

• Supportsstaff through orientation, training and oversight. Will attend monthly organization meetings/trainings to enhance SuperUser role within the practice.

• Is a team player who works closely with others and who is flexible in dealing with the changing priorities. Is a self-reliant individual who synthesizes Their knowledge of practice operations in order to problem-solve, prioritize and facilitate complex transactions in the course of Their daily activities.

Living Pride Standards

Service Excellence

1. Demonstrates service excellence by following the Everyday PRIDE Guide with the UCSF Medical Center standards and expectations for communication and behavior. These standards and expectations convey specific behavior associated with the Medical Center’s values: Professionalism, Respect, Integrity, Diversity and Excellence, and provide guidance on how we communicate with patients, visitors, faculty, staff, and students, virtually everyone, every day and with every encounter. These standards include, but are not limited to: personal appearance, acknowledging and greeting all patients and families, introductions using AIDET, managing up, service recovery, managing delays and expectations, phone standards, electronic communication, team work, cultural sensitivity and competency.

2. Uses effective communication skills with patients and staff; demonstrates proper telephone techniques and etiquette; acts as an escort to any patient or family member needing directions; shows sensitivity to differences of culture; demonstrates a positive and supportive manner in which patients / families/ colleagues perceive interactions as positive and supportive. Exhibits team work skills to positively acknowledge and recognize other colleagues, and uses personal experiences to model and teach Living PRIDE standards.

   • Exhibits tact and professionalism in difficult situations according to PRIDE Values and Practices

   • Demonstrates an understanding of and adheres to privacy, confidentiality, and security policies and procedures related to Protected Health Information (PHI) or other sensitive and personal information.

   • Demonstrates an understanding of and adheres to safety and infection control policies and procedures.

   • Assumes accountability for improving quality metrics associated with department/unit and meeting organizational/departmental targets.

Work Environment