Patient Care Coordinator

Our Patient Care Coordinator is accountable for the intake functions and ongoing maintenance of Pentec Heath, Inc’s patients. The primary goal for the position is to ensure the timely, seamless handling of our patient referrals and the accurate qualification of patient benefits and insurance carrier criteria. This is inclusive of referral source communications to ensure complete medical information is obtained, direct payor communications to determine coverage and secure necessary authorizations.

Critical features of this job are described under the heading below. They may be subject to change at any time due to reasonable accommodation or other reasons.

Essential Job Duties

• Gather and document a detailed and comprehensive understanding of the various insurance plans and benefits for the different payor classes (State Medicaid, Commercial insurance and Medicare plans) and being able to effectively communicate the therapy and coverage requirement to the Referral source, Patient and Payor sources.
• Possess professional telecommunications skills to effectively articulate benefit information, clinical and financial needs, and/or challenges to patients, referral sources, insurance carrier representative and internal teams in order to facilitate the referral process and obtain complete information required to initiate a patient’s start of care.
• Apply extensive prior and current knowledge of insurance carrier requirements and authorization practices to capture and communicate appropriate clinical and financial data required to obtain approval/authorization of service, professionally documenting the detailed outcome of this process in CPR+.
• Provide Supervisor/Manager with feedback and suggestions for improving the process, bringing immediate attention to any areas preventing achievement of goals and objectives.
• Maintains accurate records and keeps current all Progress Notes to streamline reporting functions and ensure adequate information is available in support of positive cash flow and collection efforts.
• Receive and process requests for ongoing patient maintenance including Rx changes & patient status changes. Completing reverifications and obtaining new authorizations as required.
• Other job duties and special projects as assigned.
  
  

Ideal Candidate Will Have

• High School Diploma or equivalent and customer service experience. 2+ year’s experience working directly with payors to obtain authorizations.
• Exceptional computer skills (MS Word, Excel, PowerPoint). Experience with CPR+ preferred.
• Self-motivated with ability to prioritize workload to ensure maximum efficiency Exceptional organization, process, critical thinking, problem solving and communication skills both verbal and written.
• Ability to work well under pressure and meet timelines with exceptional attention to detail. Excellent track record of customer satisfaction and proven performance and history in related field.
• Working knowledge of Home Infusion, Specialty Infusion, Dialysis, Durable Medical Equipment and/or Nutrition Therapy a plus.
  
  

Salary Range

Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location.

Benefits may include but are not limited to medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits