Health Plan Coordinator (Rehab) - 30110

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.

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.