Job Description

Job Description

Job Description

POSITION SUMMARY: Responsible for oversight, coordination and monitoring of scheduling activities as performed by the Patient Support Representatives and Managed Care Patient Navigators. Ensures efficient daily operations, quality outcomes and internal and external customer satisfaction. Performs auditing of billing codes and plan metrics/provider incentives. Facilitate the coordination of care by navigating patients through the medical and dental process to achieve desired outcomes as well as compliance with all protocols, regulatory matters and quality initiatives and standards.

Education:

1. LPN or RN, RN preferred.

Experience:

1. Minimum 3 years in a clinical setting required.
2. Minimum 3 years EMR and patient scheduling/patient support experience required.
3. Call center experience preferred.

Skills and Abilities

1. Knowledge of Third Party, commercial insurance for medical, dental, and behavioral health, Medicare and Medicaid payers.
2. Excellent computer skills including the use of electronic medical record and practice management system (NextGen).
3. Ability to work in a fast paced and changing environment including being flexible and using initiative.
4. Ability to work flexible hours which may include working weekends to provide adequate coverage.
5. Understanding of organizational policies, procedures and external governmental agencies.
6. Excellent organizational and multitasking skills
7. Intermediate proficiency level with Outlook, Word and Excel
8. Excellent team building skills and ability to work collaboratively with internal departments and external organizations.
9. Ability to maintain a professional attitude and demeanor at all times.
10. Effective time management and problem-solving skills both verbal and written communication.
11. Possesses high job accuracy, efficiency and dependability.

Transportation Requirement: Possession of a valid driver's license and automobile with insurance coverage as required by the State of Missouri preferred.

License(s)/Certification(s) Required: CPR Certification

Essential Functions

1. Monitor a caseload of managed care patients for compliance with appointments, prescriptions, immunizations, education and health/dental care utilization.
2. Supervise the Managed Care Patient Navigators and Patient Support Representatives, which includes tracking attendance, completing performance appraisals, and assisting with the interviewing of new staff.
3. Responsible for improving communication and collaboration among the patient navigators and other departments.
4. Complete periodic audits on patient billing codes per DRVS and portal data provided by managed care plans to confirm appropriate requirements provided by our organization's providers.
5. Assist with training of Patient Support Representatives and Patient Navigator staff to include scheduling, patient flow, and competency standards are met.
6. Coordinate and facilitate monthly coaching sessions.
7. Maintain supply inventory for location.
8. Monitor all daily assignments of the Managed Care Patient Navigator staff to ensure accuracy and completion.
9. Track compliance monthly with PCOR and DCOR reporting per plan as well as design budget expectation for organization regarding plan rewards programs.
10. Keep Department Director abreast of all issues that need to be addressed.
11. Maintain a positive work relationship and team approach with health center team, which includes nurses, managers, vice presidents, and providers.
12. Responsible for identifying and resolving any barriers to timely care gap closures and reporting any concerns to Chief Medical Officer and others as requested for timely interventions.
13. Perform other duties as assigned.

1. Attend meetings as required.
2. Assist providers in completing all medical documentation needed to close care gaps.
3. Assist in preparation of monthly reporting.
4. Train, understand and assist with patient appointment templates to various audiences.

Supervises: Managed Care Patient Navigator, Managed Care Patient Coordinator, Patient Support Representative, Patient Support Coordinator

NOTE: SMOKING IS PROHIBITED IN THE WORK ENVIRONMENT

NOTE: ALL APPLICANTS MUST PROVIDE CONTACT INFORMATION FOR THREE REFERENCES

AN EQUAL OPPORTUNITY SERVICES PROVIDED ON A NON-DISCRIMINATORY BASIS

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