Implantable Care Coordinator

Who are we?

American Pain Consortium’s Center for Pain clinic is one of the oldest free standing non-hospital affiliated pain centers in the Midwest (originally established in 1993). Our Indiana clinic footprint includes Avon, Carmel, Evansville, Indianapolis, Greenwood, Kokomo, and Lafayette while our Ohio footprint includes Columbus, Dublin, Fairfield, and Springfield. We also have five Ambulatory Surgery Center locations. Our caregivers build strong teams that deliver exceptional interventional pain management care.

As an employer, our mission is to empower every member of our team to realize their maximum professional potential and create an environment conducive to our shared success. Our “why” centers around our 7 inspirations: the pursuit of excellence, empathy in everything we do, a culture of collaboration, open communication, creating a space for belonging, and ongoing innovation, which yields the result of bringing value.

What do we do?

Our clinical multidisciplinary approach to care delivers the correct intervention to each and every patient, each and every time through various pain management procedures including injections, open surgical cases with general anesthesia, physical therapy, and psychological services. Our Providers focus on helping individuals improve functionality to restore a more meaningful lifestyle.

Behind the scenes are APC’s support departments which include areas like Operations Support, Pre-Service, Billing, Human Resources, Marketing, and Accounting. APC values individuals with a strong work-ethic, embracing why they want to serve in the healthcare industry while maintaining a work, family, and life balance. APC is seeking an individual who is eager to learn, develop, and grow in a role in the Implantable Care Management Department located in the Support Office in Carmel, IN.

Job Summary

The Implantable Care Coordinator will facilitate all administrative components of the patients’ experience and entrance into any American Pain Consortium facility or site in relation to Intrathecal Clinical Care. This may include scheduling, pre-registration, order entry, benefit verification, financial counseling, pre-certification, billings, and collections.

Essential Duties & Responsibilities (What You’ll Do)

• Ensures departmental compliance of entering correct data into the appropriate systems for standard workflow documentation
• Ensures departmental compliance by auditing physician orders compared to actual scheduled procedure to confirm accuracy
• Responsible for the timely pre-certification, authorization, financial counseling, and verification of insurance coverage
• Responsible for the accurate charge capture, billing, and rebilling of services provided as directed. Responsible for posting procedures, modifiers, diagnosis codes to claims from identified population
• Verifies for accuracy and potentially procures all of the following: eligibility, benefits, charges, medical policies, precertification, and insurance accuracy before submitting claims and identifies and develops mechanisms for missing charges.
• Answering incoming phone calls from vendors, insurers, facilities, patient or patient's family, and field staff about account inquiries regarding both patient and insurer liabilities. Review patient liabilities for accuracy and completeness and obtain any missing information.
• Contact insurance companies to work out any discrepancies resulting in claims resolution and remittance. Communicate payment or denial trending that impacts revenue to all stakeholders.
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
• Meets and/or exceeds productivity standards set by supervisor for assigned accounts and claims
• Reviews and utilizes a number of reports in the aging of assigned accounts to prioritize follow-up. Researches, appeals, and resolves claim rejections, underpayments, and denials with payers utilizing all resources available.
• Verify completeness including accurate patient status, CPT code, ICD-10, and other components necessary for patients assigned. Follow up with applicable staff to obtain correct orders and clinical information that supports medical necessity for services being rendered.
• Resolves patient issues in a concise and informative manner notifying applicable staff, providers, and patient of authorization denial or downgrade.
• Engage in process design and recommendations for improvement of flow and patient experience.
• Participates in continuous process improvement activities to meet goals
• Assist in research and follow-up for denials and in creating a plan to prevent future denials.
• Validate pre-cert/pre-auth information after receiving final determination prior to date of service. Complete medical necessity and/or pre-determination requirements when applicable. Communicate issues or appeals/escalates appropriately.
• Other duties as assigned

Minimum Qualifications (What We Are Looking For)

• Excellent verbal and written communication skills.
• Excellent interpersonal and customer service skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Strong analytical and problem-solving skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to function well in a high-paced and at times stressful environment.
• Proficient with Microsoft Office Suite or related software.

Education and/or Experience Requirements

• High school diploma
• Minimum 24 months administrative experience in a medical facility, health insurance, or related area preferred
• General knowledge of all healthcare insurance payers and authorization guidelines required
• Prior scheduling, pre-certification, and medical terminology required
• Knowledge of function and relations within a healthcare clinic environment required

Competencies

To perform the job successfully, an individual should demonstrate the following, which is included, but not limited, to:

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Customer Service - Responds promptly to customer needs; Responds to requests for service and assistance; Meets commitments.
• Respect for Others - Treats patients, physicians, and colleagues in a professional, respectful, compassionate manner.
• Respect for Privacy - Handles all patient, company, and staff information in a confidential manner compliant with all state and federal regulations and the APC Code of Conduct.

Physical Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standing and/or walking 10% of time
• Sitting 90% of the time
• Occasional lifting, stooping, kneeling, crouching, and reaching.

Supervisory Responsibilities

This position has no supervisory responsibilities

Benefits (Work Perks)

Included for all full-time positions

• Medical, Dental, and Vision Insurance
• Paid Time Off
• Paid Holidays
• Matching 401K plan
• Other

Equal Employment Opportunity

American Pain Consortium Management, its affiliates, and subsidiaries are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, protected veteran status, national origin, sexual orientation, gender identity or expression (including transgender status), genetic information or any other characteristic protected by applicable law.

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: In person