Patient Care Coordinator II

The Patient Care Coordinator II is a full -time position within Tulane University Medical Group. This Coordinator is responsible for scheduling ambulatory and inpatient care with the hospital, ambulatory facilities, and post-acute care facilities when a clinical service is determined to be needed by a patient. Verifies patient’s insurance and benefits paid by third parties. The coordinator obtains authorizations required from private, commercial, and government carriers for patient treatment, and commercial works with patients’ insurance companies to meet their specific information requirements for specific services.

The Coordinator works directly with the patient and facility, answering insurance questions as appropriate and confirming the service schedule. This position is not responsible for providing care to patients.

This position works closely not only with the payors and patients to get authorization for payment for services, but with all care providers of the Tulane University Medical Group: physicians, advance practice professionals, case managers, case workers, nurses, facility staff/schedulers, financial advocates, to determine if care is to be funded by the patients’ health insurance or some other method. Works to resolve issues that arise during the authorization process and during follow-up. The position requires a significant amount of independent and unsupervised work. Position requires critical thinking skills and autonomy to resolve payment concerns of the complicated care of patients and providers, including addressing the requirements of payors for information and documentation of medical necessity and clinical need for services to be rendered. Position is critical to physician billing and claims going out “clean” for quick review and payment.

Responsibilities

• Knowledge of eligibility and benefit verification, and referral authorization processes and procedures.
• Demonstrated overall knowledge of claims and authorization processing for insurance companies, including private, commercial, and government carriers.
• Knowledge of medical terminology, ICD-9/10, HCPCS and CPT codes.
• Working knowledge of EMR software.
• Demonstrated knowledge of managed care and health insurance payment processes.
• Ability to handle a high volume of patient flow with comfort and confidence.
• Ability to write correspondence, including a careful summary of a patient’s health care and services delivered.
• Ability to effectively present information in one-on-one and small group situations to patients, third-party payors, and other employees of the organization.
• Ability to effectively carry out detailed written and/or oral instructions.
• Knowledge of MS Excel and MS Word.
• Ability to work independently within a team setting.
• Ability to navigate through various software applications
• Ability to navigate and maneuver through multiple websites.
• Ability to maintain confidentiality in all work performed.

Qualifications REQUIRED EDUCATION AND EXPERIENCE:

• High school diploma or equivalent.
• Two years’ experience using an electronic patient account system for third-party insurance eligibility verification.

Preferred Qualifications

• Understanding of a medical practice and the relationship between physician clinic, post-acute care facilities, hospital services, and other operations related to patient registration, referrals, accounts receivable, etc.
• Experience specifically in a Hospitalist practice.

About Us Tulane University is an equal opportunity educator and employer committed to providing an education and employment environment free of unlawful discrimination, harassment, and retaliation. Legally protected demographic classifications (such as a person’s race, color, religion, age, sex, national origin, shared ancestry, disability, genetics, veteran status, or any other characteristic protected by federal, state, or local laws) are not relied upon as an eligibility, selection or participation criteria for Tulane’s employment or educational programs or activities.

Tulane University is responsible for providing reasonable accommodations to individuals with disabilities throughout the applicant screening process. If you need assistance in completing an application or during any phase of the interview process, please contact the Office of Human Resources by phone at 504-865-4748 or by email at [email protected] .