Outpatient Service Coordinator - ABA Therapy

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Responsible for overseeing and managing the patient during pre- and post-service access processing including verification/certification of patient care services to ensure the financial viability of the clinic. Assists with coordination of care provided by interdisciplinary team facilitating communication to patients, care givers as well as third party payers and referring providers.

Minimum Qualifications

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Master’s Degree in Social Work OR Rehabilitation Counseling
• Current or temporary Licensed Certified Social Worker (LCSW) OR Licensed Independent Clinical Social Worker (LICSW) OR Certified Rehabilitation Counselor in state of West Virginia. Permanent licensure within 90 days of hire OR if a recent graduate, must be working with a current provisional or temporary West Virginia permit.
  
  

Experience

• 3 years’ experience with healthcare reimbursement.
  
  

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Identifies and obtains reimbursement authorization on all patients requiring pre-certification or pre-authorization prior to services being provided.
• Documentation within appropriate EPIC modules.
• Obtains necessary clinical documentation from the requesting provider to use in the pre-certification process.
• Documents referrals/authorization/certification numbers in the registration/EPIC systems.
• Coordinates the scheduling of patients for outpatient therapy in order to organize and ensure quality patient care. Maintains master schedules in EPIC (patterns and templates) for each therapist in the department. Update daily with vacations, meetings, classes, etc. to assure accurate schedules.
• Coordinates treatment planning and maintains ongoing contact with referring providers to facilitate transitions of care.
• Respects the confidentiality of all patient information and conforms to hospital/departmental policies on the handling and disclosure of patient information.
• Assesses patients and members of their support system in order to identify potential needs, to determine appropriate level of care and to identify necessary interventions.
• Takes an active role in the coordination and facilitation of goal-oriented family meetings.
• Works with Financial Counseling to facilitate reimbursement opportunities.
• Evaluates, coordinates and acts in accordance with current laws and hospital policies in reporting targeted populations (suspected child/disabled adult/elder abuse or neglect).
• Demonstrates a high level of initiative and performs as a self-starter in daily activities.
• Acts in a professional, caring, customer service focused manner in all interactions with patients, families, peers, medical team members and community agency representatives.
• Supports and participates in multidisciplinary patient/family education and care planning with the entire healthcare team.
  
  

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit for prolonged periods of time, manual dexterity.
• Heavy/Hard work: Work requires strength and/or stamina, lifting, moving, stooping, reaching, standing, walking, and carrying of materials and equipment weighing 40 lbs.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
  
  

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office environment
• Clinical setting
  
  

Skills And Abilities

• Skill in organizational matters, including time management, prioritization, multitasking, and problem-solving.
• Ability to establish and maintain effective working relationships with patients, physicians and other clinical staff, and the public.
• Ability to use excellent customer service, written and oral communication skills.
• Adheres to the established Performance Expectations for WVUH Employees in the areas of People, Service, Performance Improvement, and Shared Values & Culture.
• Basic knowledge of computer programs such as word processing, spreadsheet and email applications.
• Knowledge of ICD-10 Codes and CPT coding, insurance authorization with Third Party Payers, payment provisions and regulations, revenue cycle operations, third party reimbursement regulations and medical terminology.
• Knowledge of all aspects of payer relations, claims adjudication, contractual claims processing and general reimbursement procedures.
• Knowledge of clinic policies and procedures.
• Knowledge of computer systems and software especially Cadence.
  
  

Additional Job Description

This position will specifically work with our Applied Behavior Analysis (ABA) Therapy program. The position can be fully remote, but local candidates will be highly considered. Please note licensure/certification requirements.

Scheduled Weekly Hours

40

Shift

Day (United States of America)

Exempt/Non-Exempt

United States of America (Exempt)

Company

WVUH West Virginia University Hospitals

Cost Center

8215 WVUH CH Pediatrics Neurodevelopment