What are the responsibilities and job description for the PACE - Member Services Coordinator position at PACE Partners of Northeast Florida?
Jacksonville, FL 32205
This position provides support to the PACE Quality and Compliance Manager and the Interdisciplinary Team (IDT). The employee is responsible for the coordination of participants outside clinical appointments, maintain scheduling records and retrieval of medical records. Schedule coordination duties include the accurate and timely communication of scheduling changes between PACE Partners and outside providers. This position also interfaces with Transportation Coordinator and Home Care Coordinator to ensure appropriate transportation and escort arrangements are made.
Qualifications and Requirements:
Education:
Duties and Responsibilities:
- Maintains a current participant roster with necessary information
- Review and process all provider orders according to established timeframes
- Updates EMR with status of appointment
- Schedules all orders in EMR adding the appointment specifics
- Creates authorizations for IDT approved services
- Coordinates with Transportation Coordinator all transportation needs
- Prepares weekly schedule of all outside appointments, including transportation and escort needs, and reports to IDT Team
- Communicates scheduled appointments with participant and/or caregiver
- Confirms outside appointment with the provider and verifies all needed information (auth, order, H&P etc.) has been received
- Obtain medical records from outside specialists and hospitals upon completion of appointment
- Controls and monitors schedule changes
- Follow-up regarding completed appointments with Clinic Manager or APRN to see if additional appointments are needed
- Checks compliance of visits done (on master schedule) after all notes are matched to charges, addressing any issues according to the orders tracking process
- Supports Quality Improvement efforts
- Comply with all state and/or federal regulations to ensure the needs of each participant is met across all care settings 24-hours a day, every day of the year.
- Comply with all state and/or federal regulations to ensure reasonable and timely access to specialists as indicated by the participant’s health conditions and consistent with current clinical practice guidelines.
- Comply with all state and/or federal regulations to ensure provision of services are documented, tracked, and monitored across all care settings.
- Comply with all state and/or federal regulations to ensure orders are scheduled to meet the participant’s current needs and/or clinical practice guidelines.
- Comply with all state and/or federal regulations to ensure all complaints regarding quality of care or service delivery are properly processed as a grievance.
- Comply with all state and/or federal regulations to ensure all individual issues within a grievance are reviewed, considered, and resolved.
- Comply with all state and/or federal regulations to ensure all participant medical records are complete, accurate and accessible to all staff.
- Protects privacy and maintains confidentiality of employee, participant, and sensitive agency information
- Supports PACE Partners mission and values
- Other duties as assigned
Qualifications and Requirements:
Education:
- High school diploma or equivalent required.
- Experience in healthcare medical records or scheduling required, Certified Medical Assistant or Certified Nursing Assistant preferred
- Must be well organized with exceptional attention to detail, able to manage scheduling, medical records and effective communication with an interdisciplinary team
Experience:
Required:
- One-year minimum of Customer Service experience.
- Must possess administrative skills including use of office technology and electronic medical records systems and excellent customer service skills.
- Have 1 year of experience working with a frail or elderly population OR, if the individual has less than 1 year of experience but meets all other job requirements, the candidate must receive appropriate training from the PACE organization on working with a frail or elderly population upon hiring.
- Basic understanding of the Health Insurance Portability and Accountability Act (HIPAA), and disclosure of Protected health Information
- Meet a standardized set of competencies for the specific position description established by the PACE organization before working independently.
- One year experience coordinating care in a health-related field.
- One year of experience providing authorizations with outside specialists.
- One year of experience with billing and accounts payable.
- One year of experience with medical records
- One year of experience coordinating general office flow.
Skills and Knowledge:
- Effective written and oral communication skills
- Excellent customer service
- Effective problem-solving skills
- Productive as both an independent and team contributor
- Ability to effectively prioritize and efficiently follow-through on responsibilities
- Proficient with necessary computer skills for the workplace to include Microsoft Office Suite (Word, Excel, Outlook, PowerPoint, etc.) and Data Management Systems
We are an equal opportunity employer.
We do not discriminate on the basis of race, color, religion, marital status, age, national origin, disability, pregnancy, genetic information, gender, sexual orientation, veteran status, or any other status protected under federal, state, or local law.