PATIENT CARE COORDINATOR at UNM Hospital (2024)

Detailed responsibilities:
* PATIENT CARE - Assist patients in locating departments; schedule and coordinate patient appointments; refer patients and families to appropriate services and resources
* PRIOR AUTHORIZATION - Complete pre-screening process for specialty clinic appointments for referral and/or prior auth
* PRIOR AUTHORIZATION - Verify coverage eligibility on patients needing prior authorization
* CODING - Abstract chart information and assign CPT, ICD, and HCPCS codes for purpose of predetermination or prior authorization
* LIAISON - Perform as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/ coverage and prior authorizations
* DOCUMENTATION - Complete and fax paperwork and pertinent medical documentation to insurance companies and other payors for approval; document final prior authorization in financial systems
* FINANCIAL ASSISTANCE - Refer self-pay patients for financial assistance; make financial assistance appointments
* COORDINATION - Coordinate with hospital and clinic surgical representatives, providers, and other applicable areas for day surgery prior authorization and/or financial coverage or assistance
* TRAINING - Perform outreach/training with clinical areas to ensure process flow remains tight and to maintain open communication
* DENIALS - Track and investigate payment denials due to "no authorization"; report detail information to supervisors and work with billing office representatives to coordinate appeal efforts
* CUSTOMER SERVICE - Identify Primary Care Physicians for all patients and communicate with the PCP as necessary; take messages for department personnel
* CUSTOMER SERVICE - Acquire prior patient records, patient billing, referral information and lab results
* CUSTOMER SERVICE - Assist referring providers in resolving problems, locate UNM physicians and forward documents
* PATIENT CARE - May assist clinical staff with routine non-invasive patient treatment procedures and initial screenings
* LEAD - May exercise functional and technical lead over lower level staff
* PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols
* PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
* PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
* PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner
* PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"
* PATIENT CENTERED MED - Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable

Experience:
Essential:
2 years directly related experience

Nonessential:
Bilingual English, Spanish, Keres, Tewa, Tiwa, Towa, Zuni, or Navajo

Credentials:
Essential:
* Not Applicable/Not Required