Care Coordinator II

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 12 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Clinical Services Coordinator provides administrative support and assists with coordination and accurate tracking of daily activities within the Clinical Services Department. Must be able to prioritize, manage multiple projects simultaneously and follow through on tasks and issues in a timely manner within a fast-paced environment.

POSITION DUTIES & RESPONSIBILITES

• Responsible for opening and closing cases, updating of notes accurately in the system, ensuring level of care and aberrant day letters are accomplished timely.
• Primary Coordinator responsible for accurate and timely processing of NOMNCs, NDMCs, DNDs, NORs and DENCs including faxing and logging each action.
• Assist Quality Department with Health Plan Appeals.
• Act as the primary liaison to the Claims Department for clarification on cases and process retrospective review requests to ensure accurate and timely processing.
• Monitor faxes with electronic fax system and log or distribute appropriately.
• Complete training and provide mentorship for all new hires.
• Responsible for facilitating communications between facilities and AZPC for timely resolution of Peer-to-Peer requests, appeals, and provider disputes.
• Periodic verification and reconciliation of data in other AZPC systems as required.
• Following external facility and HIPAA guidelines, extracts data from various facilities Electronic Medical Record systems.
• Answers incoming calls timely and transfers to appropriate staff/department or takes messages accurately.
• Frequent checks of incoming telephone queue voicemail. With prompt return of calls, if applicable.
• Responsible for maintaining relationship with facilities to ensure clinical documents are received in a timely manner for concurrent review and PCP care coordination.
• Communicate effectively with the Health Plan(s), physician, providers, facilities, coworkers and nurses.
• Communicate timely to Eligibility department when updates are needed.
• Responsible for Hospice verification on CMS website.
• Assist with coordinating monthly vendor meetings and sending Palliative and ICM referrals.
• Ensure that Complex Care Management, Palliative, and Home Health cases are logged appropriately and that proper documentation is received.
• Responsible for assisting Care Coordination Manager and/or Director with monthly reporting of Health Plan data.
• Must be flexible, with ability to rotate weekend coverage.
• Responsible for processing incoming and outgoing mail timely and accurately.
• Acts as back-up to the Care Coordination Manager for pertinent functions.
• Primary trainer of new Care Coordination positions.
• Special projects as needed.
• Performs other duties as assigned.
  
  

Education, Training And Experience

• High school diploma or equivalent (GED) required.
• Minimum of 2 years previous experience in the medical field, with knowledge of medical terminology.
• Moderate level proficiency in multiple software applications including Microsoft Outlook, Excel and Word.
• Proficiency in all internal applications.
• Excellent verbal and written communication skills.
• Must be detail-oriented, able to prioritize and multi-task effectively in a fast-paced environment.
• Able to interact effectively with all levels of the organization and external customers.
• Ability to efficiently operate office equipment including computer, phone, fax and photocopier.
• No driving required.
• This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.*
  
  

The compensation range for this position is: $24-$26/hr