Outpatient Coordinator Lead

Regal Medical Group•Los Angeles, CA

2d•$27 - $28

About The Position

The Outpatient Coordinator Lead is responsible for navigating the care management across the continuum of care of the member from acute to outpatient case management. The Outpatient Coordinator Lead’s role is to incorporate administrative job functions to provide optimal care and coordination of care for members. The Outpatient Coordinator Lead will assist the case management team in care coordination during the transition of care levels. The Outpatient Coordinator Lead will be responsible for developing relationships with members and providing support, encouragement, and health education. Responsibilities include but are not limited to assisting in scheduling medical appointments, durable medical equipment, home health, eligibility/benefit verification, requesting medical records, data entry, review of medical management reports, and referral processing as needed. The Outpatient Coordinator Lead will work closely with nurse, doctor, and management staff to coordinate care for members delegated or assigned. The Outpatient Coordinator Lead is responsible for coordinating non-clinical tasks to support the delivery of care coordination to members who meet case management criteria. The Outpatient Coordinator Lead promptly, efficiently and accurately processes referrals as needed. Facilitating the right care at the right time in the right setting. Maintain turnaround time compliance in all aspects of the referral processing as part of care coordination with members primary care physician/specialist. Promote the quality and cost effectiveness of medical care through adherence to UM Policy and procedure. The Outpatient Coordinator Lead will maintain and complete work within due dates/timelines based on regulatory compliance expectations. Expected to promote excellent team work by collaborating in process improvement efforts. The Outpatient Coordinator Lead is responsible for conducting calls to members to engage into case management programs. Collaboration with doctor’s office for referral processing requests and or expediting referrals. Participation in quality audits for the coordinators as well as attendance of Health Plan Audits. Creation of job aids and tools for the department. Serves as preceptor in the team. Collaborates with Leadership in process improvement.

Requirements

Must have 3+ year in the Outpatient Coordinator II role
Annual Performance review of exceeding expectation (3.00 or above) in 2 or more years in a row
High school graduate required
Strong analytical skills with the ability to organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy required
Ability to work independently while collaborating in meeting team goals
Typing 40 words per minute
Data Entry accuracy
Attention to Detail
Availability to work consistently in scheduled time as well as Overtime as needed
Mastery level of operating computers, faxes, printers and all other equipment
Mastery level in MS office programs in intermediate or above level: Excel, Word, Power Point, and Outlook
Ability to follow HIPAA confidentiality policy and procedures
Ability to work in a fast pace environment
Flexible and adapts to process changes
Proficient conflict resolution experience
Proficient in critical thinking and problem solving
Ability to communicate clearly
Completion of courses/training as described in Essential Duties

Nice To Haves

6 years of healthcare setting and Managed Care experience preferred
6 years of customer service experience preferred
Bilingual Preferred
Medical Assistant certification, Associates or Bachelor preferred
Medical terminology, ICD10, and HCPC coding preferred

Responsibilities

Ability to remain positive in a fast paced environment
Documents clearly and concisely in members file using directed documentation style
Ability to time manage in a high work environment
Follow process protocols efficiently and report any areas of process improvement to leadership
Adaptability to consistent process changes
Ability to remain organized throughout the day to allow quality and productivity.
Ability to maintain, read, respond to all outlook communication in a timely manner.
Maintenance of Fax Servers as delegated
Able to use system resources to increase productivity and organization
Ability to recognize and communicate when assistance is needed and ability to assist others when time is available but also when instructed to do so.
Adherence to timekeeping policy expectations
Welcome constructive criticism as an opportunity to learn and grow
Communicate in a clear and concise manner
Follow best practice email etiquette with HIPAA best practices
Ability to use chain of command when escalating barriers
Coming up with innovative solutions and proposals to leadership
Ability to use critical thinking and problem solving
Demonstrate integrity and character in the face of overwhelming challenges
Ability to take responsibility over member and tasks and resolving issues timely
Responsible for contacting members to provide necessary wellness education to improve self-management skills and enhance patient provider communication.
Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of involvement they need.
Returns phone calls to customers and follows up with requests in a timely manner.
Ability to maintain high call volume; incoming and outgoing calls.
Assists other staff and supports the team approach.
Demonstrates honesty and integrity in everyday activities.
Protects privacy for both patients and employees; ensures all personal health information is kept confidential i.e., (sensitive papers, charts, and reports are not in view of the public).
Recognizes when an error has been made and immediately reports to appropriate management staff.
Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy.
Functions as liaison between care managers, patients, physicians, and other healthcare providers.
Assists team with coordination of services such as home health, DME, physician appointments, specialist appointments, and transportation.
Identifies members from daily discharged list that have been admitted to a facility and coordinate the discharge plan. (as applicable)
Requests admission and discharge records for coordination of care. (as applicable)
Notifies providers of patients’ admission and health status and verifies patient follows up post discharge. (as applicable)
Follows post discharged members from acute and SNF settings and assist in implementing discharge plans. (as applicable)
Checks benefits and identify member’s program eligibility.
Ability to maintain system processing as directed.
Processes referrals based on Discharge Plans and orders sent by Case Manager and or Physician.
Maintains turnaround time compliance in all aspects of the referral process and OPCM regulatory compliance.
Demonstrates outstanding customer service skills with a can-do attitude.
Consults other departments as appropriate to provide services to member’s needs.
Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
Maintains all reference material that is provided by the supervisor, manager or director.
Knows and follows the Employee Handbook policies and procedures.
Maintaining Individual Excel Logs with accurate data, in a timely manner. Responsible for saving Individual Excel Logs in a consistent basis to allow real time review of data in the log.
Participate in on-going training and in-services as needed.
Excellent documentation skills.
Ability to work independently.
Able to be flexible and adapt to rapidly changing work environment.
Expected to be dependable and a trusted part of the team by proactively communicating with peers and leadership in a collaborative manner.
Ability to keep motivated through fast paced environment and escalating to leadership as needed.
Ability to remain focused on achieving delegated assignment.
Expected to use directed tools and templates to perform delegated job duties.
Use of Language Line provided to communicate with non-English speaking members.
Able to process referrals as needed as part of care coordinator for members
Participate as preceptor in occasion as scheduled by Lead/management
Delegated UTC and Declined ICT Prep template completions
Crossed trained in phase 1 and phase 2 process and 2 or more lines of business
Able to work PDC and DCP (as applicable to team assignment)
Able to assist PDC and OPCM (as applicable to team assignment)
Present a topic during meeting (at least 1 time in a year)
Independently takes initiative in organizing and increasing work pace in their own case load to allow for extra time to assist peers.
Demonstrates the ability to follow through with request
Assist level I outpatient coordinator as needed in complex calls
Ability to review case and identify and provide constructive feedback to peers (CC/CMs) and inform leadership of feedback.
Expected to time manage and able to complete their work and assist others
Expect to serve and volunteer for Overtime when team needs to meet deadlines
HR Courses/Training from Employee Services Complete 3 out of 5 identified trainings: Identifying & Solving Problems Customer Service Making Decisions, Weighing Risk Giving Clear Information Time Management Effectiveness Profile
Praxis/IRR – MediCal, UM, non-clinical pertinent trainings as delegated by management
Action driven to results of their work
Training as needed for CCs and CMs
Assigned mentor and review of outpatient coordinator I & II individual logs for accuracy
Proposal of process improvement (at least 2 -5 in a year)
New Hire Preceptor/Shadowing
Requesting HLP portal access set up for new hire
New Hire Quality Audit completion to be completed within 40 days of new hire start date
ADHOC Health Plan Audit (Listen-in Audits)
Assist in Outpatient Coordinator Audits and sit with Lead(s) to provide the results
UM Referral TAT Knowledge/Processing. (IRR Prior Authorization Testing)
Job Aid Creation & Maintenance
Data Analyst assistance in HLP reporting as needed
Delegated UTC, Declined and Engaged ICT Prep template completions
Serve as presenter in during monthly meeting for approved topic
Scheduling Fax Server Rotation
Rotation of monthly review of the P drive for any NDN & MLI version updates
Cisco Hunt Group Voicemail rotation
Performs other duties as directed by management.