The Outpatient Coordinator is responsible for coordinating non-clinical tasks to support the delivery of case to members who meet case management criteria. Responsibilities include but are not limited to assisting in scheduling medical appointments, durable medical equipment, home health, eligibility/benefit verification, requesting medical records, data entry, and review of medical management reports. The outpatient coordinator is accountable for outreaching members telephonically to introduce and invite them to Case Management. Care Coordinator will maintain high quality and reliable information related to reports, data, cases, and be able to identify and report any discrepancies. Creating and developing a team play approach by being a good communicator and being flexible to the needs of the department.

Essential Duties and Responsibilities include the following:

• Assists Outpatient Case Manager(s) with arranging services for members, such has home health, DME, physician appointments, specialist appointments, and transportation.
• Follows up with patients to ensure arranged services are received.
• Maintains turnaround time compliance in all aspects of the case management Standards of Operation.
• Keeps patient and/or family members or other customers informed of care coordination.
• Assists other staff and supports the team approach.
• Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• Demonstrates honesty and integrity in everyday activities.
• Protects privacy for both patients and employees; ensuring all personal health information is kept confidential i.e., (sensitive papers, charts, and reports are not in view of the public).
• Recognizes when an error has been made and immediately reports to appropriate manager.
• Participates in “service recovery” through follow-up with an upset member, gathering information, and demonstrating empathy.
• Treats members and their families with respect and dignity.
• Functions as liaison between administration, members, physicians, and other healthcare providers.
• Interacts professionally with other healthcare service providers.
• Communicates appropriately and clearly to management, co-workers, and physicians.
• Consults other departments as appropriate.
• Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
• Maintains all reference material that is provided.
• Knows and follows the Employee Handbook policies and procedures.
• Must maintain 95% benchmark in quality audits.
• Must maintain high productivity based on membership and case load volume.
• Maintain a low Unable to Reach/Contact & Declined rate.
• Must assist team in case load as needed.
• Must not have abandoned calls.
• Timely fax server review and clearance.
• Attend meetings timely and participate with constructive feedback.
• Have a ‘Can Do’ attitude.
• Be Proactive in anticipating the needs of the department.
• Create an open communication environment by asking questions when in doubt.
• Reporting if there are system issues that affect productivity.
• Distribution of work: Daily production will vary from day to day. All assigned work must be completed by the end of business day in order to maintain customer service to members and turnaround time compliance.
• Protect member’s privacy and adhere to HIPAA regulations at all times.
• Follows company policy.
• Remains flexible and open to process changes and updates.
• Arrives each day fully prepared to tackle job responsibilities.
• Remain objective.
• Problem Solve using resources and innovative ideas.
• Performs other duties as assigned.

Requirements:

• High school graduate required.
• 1+ years of experience and knowledge of Healthcare & Managed Care preferred.
• Typing 60 words per minutes with accuracy.
• Knowledge of computers, faxes, printers, and all other equipment.
• Proficient in MS Office programs (i.e., Word, Excel, & Outlook).
• Ability to deal with responsibility with confidential matters.
• Ability to work in a multi-task, high stress environment.
• Ability to be flexible with changes in process and procedures.
• Critical Thinking
• Experience with HMO, Medicare, and or MediCal
• Good phone etiquette
• Professionalism
• Strong analytical skills with the ability to organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Paid Time Off (PTO)
• Company celebrations
• Employee Assistance Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Weekend availability

COVID-19 considerations:
(Remote position until further notice)

Experience:

• Medical terminology: 1 year (Preferred)
• Managed Care: 1 year (Required)

Language:

• Bilingual (Preferred)

Work Location: One location

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