Associate Patient Care Coordinator - Family Medicine - Prohealth Physicians

Company: UnitedHealth Group
Location: Middletown
Posted on: September 15, 2023

Job Description:

Opportunities with ProHealth Physicians, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind -Caring. Connecting. Growing together. -Positions in this function are responsible for overseeing and participating in day to day clinical care of patients. -Employees are involved in direct patient care (in a clinic, in-home care, etc.)Positions in this function are responsible for checking in, scheduling appointments, answering billing questions and managing patient medical records for a clinic. Roles may vary based on the size of the clinic(s).Middlesex Family Practice has an opening for a full-time Associate Patient Care Coordinator. - The hours for this role are Monday-Friday 8:45a-5:15p with at last one late night from 10:30a-7p and rotating Saturdays from 9a-1p. - Schedule will be determined by Practice Manager upon hire. -General Job Profile

• Limited work experience
• Works on simple tasks using established procedures
• Depends on others for guidance
• Work is typically reviewed by othersPrimary Responsibilities:
  • Applies knowledge/skills to basic, repeated activities
  • Demonstrates minimum depth of knowledge and skills in own function
  • Responds to standard requests
  • Requires assistance in responding to non-standard requests
  • Solves routine problems by following established procedures
  • Others prioritize and set deadlines for employee
  • Works with others as part of a teamYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualification:
    • High school education or equivalent experience
      Functional Competencies:
      • Engage and Work Directly with Patients - - - - - -B) - -Developing
        • Respond to patient questions in person or over the phone
        • Greet patients and build rapport to provide a positive patient experience
        • Collect patient payments
        • Make patient follow up calls (e.g., after procedures, admissions, or ER visits) to identify/close gaps in care
        • Ask patients for and/or assist patients with completing required paperwork (e.g., health history, insurance documentation, etc.) -Connect patients with outside resources (e.g., community resources, social services) to promote self care
        • Review and support implementation of patient plan of care
        • Work directly with patients to identify specific needs and/or request adjustments to plan of care
        • Coordinate services/case management for non-episodic and non-catastrophic cases
        • Manage/respond constructively to challenging patient interactions (e.g., address lack of understanding, socioeconomic challenges, frustrated patients, language barriers)
        • Explain and talk to patients or caregivers about sensitive health care decisions such as advanced directives, physician's order for life sustaining treatment, and palliative care/hospice referrals
        • Explain and ensure understanding of details related to patient care (e.g., , home health care transition procedures)
        • Explain medical benefits/coverage specifics (e.g., procedures/amounts covered, denials of coverage, appeal rights) -
        • Utilize Computer Systems to Pull/Verify/Enter Patient Data - - - - - - - - - - - - - -B) - -Developing
          • Access insurance plan systems to verify insurance eligibility/benefits for patients and seek additional information as necessary -Input/update patient demographic data into computer system
          • Update/upload patient care data (e.g., care plan data, inpatient data, patient program flags) in computer systems
          • Document patient interactions in appropriate systems/logs (e.g., medication changes)
          • Enter/process patient referral data (e.g., medical services, radiology, durable medical equipment)
          • Generate reports on patient data through relevant computer systems/applications -
          • Review/analyze patient data reports (e.g, discharges, hospital admissions/readmissions, skilled nursing facilities) and follow up as necessary
          • Identify inconsistencies in diagnosis/procedure codes and update codes in the system -
          • Enter patient payments, prepare deposits, and balance daily deposit log/ledger
          • Draft/provide written communications to patients (e.g., standard letters, welcome letters, educational materials) in compliance with company and health plan guidelines
          • Maintains patient/staff data and generates aggregate data reports -
          • Organize/Schedule Patient Services/Appointments -B) - -Developing
            • Verify referral approval prior to scheduling appointments
            • Schedule patients for walk-in or future appointments
            • Ensure provider templates/procedures are built correctly to schedule appointments in appropriate time slots
            • Ask patient questions to verify patient data or needs for scheduling
            • Coordinate/confirm scheduling of doctor visits/services with patients -
            • Make calls to doctor's office on patient's behalf to schedule, check progress, and facilitate the care process
            • Identify resources available to support patient care (e.g., housing, social services, meals)
            • Work with durable medical equipment providers/obtain durable medical equipment for patients -
            • Manage patient referral process (e.g., review for duplicates, ensure referral is sent to appropriate provider, follow-up with requesting provider to recommend changes)
            • Engage physician to obtain or provide information related to patient care (e.g., modifying authorizations, redirecting care, clarifying orders/notes)
            • Maintain open communication and rapport with physicians to promote patient services/care
            • Ensures patient scheduling/follow up activities are completed according to federal, state, or organizational guidelines (e.g., referral guidelines, follow up notifications, PCP follow up) -
            • Screens/forwards incoming calls from patients, physicians, and health plans -
            • Demonstrate Business/Industry Knowledge - - - - - - - - - - - - -B) - -Developing
              • Demonstrate understanding of relevant health plan guidelines and benefits (e.g., Medicare, Medicaid/Medical, commercial benefit plans, Federal/local government regulations)
              • Demonstrate understanding of Federal privacy regulations (e.g., HIPAA)
              • Demonstrate knowledge of safety guidelines/practices (e.g., OSHA)
              • Demonstrate knowledge of basic medical terminology and human anatomy to document patient information using standard language/medical terminology
              • Apply understanding of evidence based practice guidelines (e.g., Millliman) to evaluate medical necessity of procedures
              • Demonstrate understanding of managed care policies/procedures that apply to patient care -
              • Demonstrate understanding of managed care practices/contract provisions to evaluate appropriateness of services (e.g., contracted providers, financial implications, relevant regulations)
                Values Based Competencies:Employee
                • Integrity Value: Act Ethically
                  • Comply with Applicable Laws, Regulations and Policies
                  • Demonstrate Integrity
                  • Compassion Value: Focus on Customers
                    • Identify and Exceed Customer Expectations
                    • Improve the Customer Experience
                    • Relationships Value: Act as a Team Player
                      • Collaborate with Others
                      • Demonstrate Diversity Awareness
                      • Learn and Develop
                      • Relationships Value: Communicate Effectively
                        • Influence Others
                        • Listen Actively
                        • Speak and Write Clearly
                        • Innovation Value: Support Change and Innovation
                          • Contribute Innovative Ideas
                          • Work Effectively in a Changing Environment
                          • Performance Value: Make Fact-Based Decisions
                            • Apply Business Knowledge
                            • Use Sound Judgement
                            • Performance Value: Deliver Quality Results
                              • Drive for Results
                              • Manage Time Effectively
                              • Produce High-Quality Work
                                Connecticut Residents Only: The hourly range for Connecticut residents is $16.00 to $27.31. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. -At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Middletown , Associate Patient Care Coordinator - Family Medicine - Prohealth Physicians, Healthcare , Middletown, Connecticut