Clinical Coordinator - Patient Engagement Center

Albany Medical Center • Albany, NY

1d • Onsite

About The Position

The role, referred to as a Clinical Triage/Authorization Nurse, is situated within the Patient Engagement Center Pre-Service and acts as the primary contact for the Primary Care Pod (Adult and Pediatrics). Key responsibilities include assessing the need for sick visits and identifying critical "trigger words" during patient/parent phone calls, guided by pre-defined triage assessments from the respective clinics. The individual will work closely with Clinic Nursing Leadership to ensure that patient requests and inquiries are handled promptly, especially those involving urgent triage triggers. A significant part of the role involves financial preparedness, specifically ensuring that payers are ready to reimburse for scheduled services in line with payer-provider contracts, and actively working to identify, mitigate, and prevent clinical denials. This entails direct communication with payers and providers via phone, portal, or fax to secure necessary authorizations. The role requires clinical expertise to review medical necessity, address authorization concerns, and resolve coverage-related issues. Additionally, the position supports the Pre-Service Team in triaging clinical complaints, trigger symptoms, and clinical inquiries, ensuring same-day follow-up for urgent cases. It also involves utilizing benefits and order information to secure pre-authorizations, communicating with various stakeholders (physicians, patients, payers, PEC Representatives, Authorization Specialists) to gather missing information, thoroughly documenting all payer communications, and managing Medical Necessity, including identifying patients requiring Medicare Advance Beneficiary Notices (ABNs). Finally, the role contributes to maintaining an accurate Authorization Requirements by Payer database and verifying that services are assigned to the appropriate setting of care by the physician's office.

Requirements

• Excellent knowledge of third-party payer authorization portals.
• Ability to organize work with multiple steps to ensure no scheduling or authorization needs are missed.

Responsibilities

• Assist the Patient Engagement Center Pre-Service as the first point of contact for the Primary Care Pod (ADULT and Pediatrics) for assessment of need of sick visit and trigger words identified through the patient/parent telephone call, through a pre-defined triage assessment provided by the respective Clinics.
• Work collaboratively with Clinic Nursing Leadership to ensure patient requests and inquiries are managed timely and triage trigger words expeditiously.
• Ensure payers are prepared to reimburse for scheduled services in accordance with the payer-provider contract and works diligently toward the identification, mitigation, and prevention of clinical denials.
• Contact payers and providers via phone, portal or fax, to secure authorizations.
• Use clinical expertise by reviewing medical necessity, responding to authorization concerns and/or reconciling coverage-related issues.
• Assist the Pre-Service Team, primarily the Primary Care (adult and pediatric) PODS to triage clinical complaints, trigger symptoms and clinical inquiries appropriately and expeditiously.
• Work collaboratively with Clinic Nursing Leadership to ensure patient is contacted expeditiously – same day for trigger word/symptom follow up.
• Use benefits and order information on file to initiate and secure pre-authorization in advance of service date.
• Communicate with physicians, patients, payers, Patient Engagement Center Representatives and Authorization Specialists to obtain missing demographic information, insurance or clinical information needed to secure authorization for scheduled services.
• Document all payer communications thoroughly and communicated payer decisions in a timely manner.
• Manage Medical Necessity as service necessitates and identifies patients needing Medicare Advance Beneficiary Notices (ABNs).
• Assist with the maintenance of Authorization Requirements by Payer database to ensure accuracy by Payer and Product line.
• Responsible for review of services being rendered to ensure the appropriate setting of care has been assigned by the physician’s office.
• Organize work with multiple steps to ensure no scheduling or authorization needs are missed.

Benefits

• Excellent health care coverage with no copay at Albany Medical Center providers
• A wide array of services and programs to support emotional, physical, and mental wellbeing

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees