Practice Coordinator 3 (Child req #5 of 18) Parent 1835

As a patient-focused organization, UCSF Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. UCSF Health seeks faculty and staff that are committed to the values of professionalism, respect, integrity, diversity, and excellence that are integral to our mission.

The Practice Coordinator 3 is primarily responsible for representing the administrative team as the public face of the Practice and works closely with the administrative, clinical and management teams to support practice operations and customer service recovery and intervention efforts. S/he provides support to all functions of the administrative teams including but not limited to: CRM messages, telephone encounters, referrals, APeX in-baskets, scanning, scheduling, filing, authorizations, and billing.

The PC 3 is responsible for the maintenance of all routine clerical operations and communications. S/he adheres to the UCSF House and Telephone Standards and is sensitive to the needs of patients, staff and providers at all times. The PC 3 is a team player who works closely with others and who is flexible in dealing with the changing priorities. S/he is a self-reliant individual who synthesizes his/her knowledge of practice operations in order to problem-solve, prioritize and facilitate complex transactions in the course of his/her daily activities.

This position makes a difference for patients in an outpatient care unit by providing excellent customer service, facilitating and ensuring the accuracy of the information flow between medical, hospital staff and departments to maximize unit efficiency. The PC 3 is required to work at any UCSF campus as needed and scheduled.

DUTIES & ESSENTIAL JOB FUNCTIONS

New Patient Scheduling and Processing 10 %

• On a daily basis reviews and works referral workqueues documenting activities within the referral record.
• Acts as the primary contact for referring physicians and new patients
• If practice utilizes a mirror system for external referrals, such as an electronic log, maintains electronic log but also creates referral record for accurate tracking and documenting of external referrals.
• Assigns new patients to providers as required, taking into account scheduling issues.
• Schedules and registers patients by telephone or in person before first appointment meeting established accuracy and performance standards. Completes appropriate practice intake paperwork and follows established practice guidelines to ensure new patients are seen within prescribed timelines. Communicates any problems with the schedule with supervisor.
• Collects and verifies insurance and referral/authorization information for first appointment
• ensuring referral records and Hospital Accounts Records (HARS) are created and assigned to the appointment.
• Schedules and coordinates any pre-appointment tests or appointments.
• Explains first appointment procedures in layman's terminology to patient including
• required records, pathology slides and radiology films to bring or send prior to the first
• visit; prepares and mails New Patient Packet or sends through MyChart; provides other
• information requested by patient.
• Gives directions and instructions to patients before the first appointment. Manages patient
• expectations by providing practice-specific guidelines related to service/visit. Seeks clinical input when appropriate.
• Creates a professional and positive first impression for patients and referring physicians.
• Demonstrates good judgment and common sense.

Advanced New Patient Scheduling and Coordination 20 %

• Secures outside medical records, CD's of scans and pathology slides; reviewing them for
• completeness; and making a determination as to which physician can best evaluate the patient.
• Understands and is able to prioritize new patient scheduling based on diagnosis and current
• treatment status to ensure complex patients are scheduled according to practice priorities (e.g. someone newly diagnosed with Stage IV colorectal cancer is seen within the week vs. a second opinion currently receiving treatment is seen within 3 weeks).
• Informs patients about possible treatment scheduling options, clinical trials and screening is coordinated with appropriate research personnel and the appropriate physician. As indicated upon screening, if the patient would benefit from a consultation with other clinical disciplines consults with the appropriate department and will work to coordinate care, to optimize schedules, and expedite services.
• At new patient visits, as appropriate meets with patient after the visit to explain how care is
• coordinated with possible clinical trials, testing, surgical procedures and care within other
• departments (e.g. general surgery, cardiology) and with other external providers.

Surgery Scheduling 3 %

• Coordinates scheduling of all outpatient and inpatient surgeries for the surgical practice. Ensures that all surgical procedures are scheduled within a clinically appropriate time frame. Interfaces with patients, physicians and hospital staff to ensure adequate communication regarding all aspects of surgical services.
• Interacts with clinical and academic staff to coordinate surgical activities with physician's other responsibilities. Processes complex hospital admission forms, schedules pre-surgical tests and appointments, and secures all necessary resources and equipment for surgery.
• Manages complex scheduling coordination related to securing OR time outside of designated block time in the operating rooms. Works to maximize both OR and surgical robots utilization as well as complex joint cases with one or more additional surgeons or other services.

Advanced Surgery Scheduling 0 %

• Coordinates pre-operative anesthesia appointments with other testing, authorization coding and scheduling the surgery in Op-Time. Additionally many cases require complex admission, discharge and planning coordination involving hospital reservations and authorizations related to study patients on protocol, transfers from outside hospitals and post transfer urgent authorizations and surgical planning.
• Works with patients and staff to confirm availability and accuracy of medical information within APeX and to ensure compliance with all hospital policies and procedures.
• Secures authorization for surgical procedures and coordinates with Hospital Admissions Department as needed. Communicates with the surgeon post-surgery to confirm if any additional surgical procedure was performed and if so to follow up with the insurance company immediately to amend the authorization. Acts as primary liaison to procedure billing team to coordinate updated authorizations and or TARs for mid procedure changes or additions.
• Ensures compliance with Medical Center bylaws and Regulations ensuring the diagnosis is confirmed before treatment is offered through formal review of any and all outside studies and pathology. The coordinator is the sole person to ensure appropriate and timely communication and documentation with the patient and the physician.
• Successfully interacts with patients to secure surgical consent for cosmetic services. This includes identification of cases, cosmetic price guidelines, quote prices and coordinate payment. Analyze the pricing structure to ensure that the prices remain competitive and are updated as needed. This position is expected to represent UCSF Medical Center's objective to grow elective cosmetic services by providing sophisticated customer service and sales
• Arranging post-surgical appointments and testing, which may or may not include Home Care, Physical Therapy, starting paperwork for durable medical equipment and following up on all other paper work, i.e. Workers Compensation as necessary

Revenue Cycle 3 %

• Performs cash collection and depositing functions as assigned, complying with all established policies and procedures.
• Communicates Medical Center administrative and financial policies clearly to patients, answering patient account questions and knowing when to refer patients to financial counseling, billing agents, patient relations or other support departments for additional help.
• Obtains and documents insurance authorizations for established patient visits, referrals and procedures or ancillary services. Communicates clinical information from medical records authorization requests to insurance companies.
• Demonstrates competency working with CPT codes and ICD-9 and ICD-10 for the purpose of scheduling and securing authorization.
• Works with patients and staff to confirm availability and accuracy of medical information
• within APeX and to ensure compliance with all hospital policies and procedures.

Moderate Complex Revenue Cycle 0 %

• Monitors provider(s) open charts and encounters and works with providers to complete encounter documentation in a timely manner to support revenue cycle workflow. May assist provider with instructions on how to close encounters opened in error.
• Works RFI work queues to secure information for accurate billing submissions or to respond to denials such as retro authorizations, clinical documentation, and addended authorizations with add on CPT codes.
• Secures authorization for procedures, specialty visits and ancillary testing and coordinates
• with Hospital Admissions Department as needed.
• Provide assistance with complex DME authorizations that often require precise documentation in specific formats to receive approval
• Provide assistance with medication authorization for new medications and refills.

Advanced Revenue Cycle 0 %

• Secures complex insurance authorizations for services, medications, or testing and is able to track the authorizations for renewal based on insurance company driven limits of time frames or numbers of visits or services.
• Has demonstrated competency working with HCPC codes and is able to look up and locate the appropriate codes for the purpose of requesting authorization (e.g. J codes for medications like chemotherapy).
• Understands how to identify and interpret a patient's insurance benefit package, including pharmacy and mental health carve outs. Utilizes this information to direct authorization requests and to coordinate these services for patients.
• Reviews & analyses monthly denial reports for both professional and hospital billing. Initiatives retro authorizations from denial report.
• Identifies trends in denials and works with practice team and supervisors to develop and implement improved workflows to minimize denials.
• Compiles & analyzes data for reports to track basic revenue cycle measurements such as charges, payments, visit volume, etc. and creates reports in Microsoft Excel. Oversees and coaches staff on complex authorization requests as they arise.
• Address patient complaints from patients regarding billing and complaints related to billing that come out of Patient Relations.
• Through reporting track patterns of billing complaints and identify patterns which can be addressed with coaching and education of staff and providers.
• Understands the concept of managed care and is knowledgeable about the resources available to the staff in regards to knowing the specific requirements of individual managed care plans. Assists patients to understand the concept of managed care.
• Reviews all upcoming visits to determine patient eligibility and assists with transitioning patients who are no longer eligible to new primary care practices through collaboration with the practice Social Worker and clinical teams.
• Department resource for insurance questions and insurance updates, including having reserved time on the staff agenda to review updates with administrative team, include important updates in the practice newsletter including drafting newsletter announcements
• As practice Super User will produce reports and review with staff cash collection barriers to improve cash collection rates for the practice.

Check in / Front Desk: 0 %

• Greets and welcomes patients making eye contact and utilizing AIDET standards.
• Determines a patient's co-pay obligation and collects it at the time of the visit; may also collect payments on patient accounts.
• Gives priority to the timely registration of patients on check-in and is aware of the ne