Who We Are
Are you interested in working for an organization whose mission it is to enable frail, underserved, and multicultural senior communities to live independently at home and in their communities, for as long as possible?
Fresno Program of All-Inclusive Care for the Elderly (PACE) is dedicated to providing its participants with comprehensive health and social supports that are proven to effectively manage chronic conditions and to reduce the risk for premature institutionalization. PACE staff are leaders in the “aging in place” industry and we have had the honor of serving Fresno, Bakersfield and Orange County seniors and their families/caregivers.
Job Summary
The Patient Access Lead is responsible for overseeing all aspects of the Order Entry, Authorizations and Scheduling process. Responsibilities include collecting all necessary documentation, contacting the referring provider office for additional information and completion of the required prior authorization form in order to proceed with the request. The Patient Access Lead will work closely with the clinical staff, outside specialty providers as well as the management team. Must display excellent communication, organization and follow-up skills with the ability to handle multiple assignments simultaneously. In addition, demonstrates good judgement as well as attention to detail.
Essential Job Functions
- Leads towards the organization’s goal in providing timely outside provider access for our participants.
- Analyzing critical paths and restraints to determine the effect of changes on the order entry, authorizations and scheduling process and recommending solutions to mitigate impacts.
- Ensure timely and effective scheduling of new patient consults and/or continuous outside care in accordance with physician and/or office guidelines.
- Ensure consistent follow-through with statistical tracking of referrals and completion of all outside patient testing, services, and appointments.
- Trains Patient Access team members on Prior Authorizations, Order Entry, Authorizations, Scheduling and Confirmation Calls.
- Obtain prior authorization information in accordance with established guidelines.
- Verify prior authorizations and/or pre-service requirements are met.
- Order Entry of all PAs received.
- Timely completion for all prior and retro authorization requests.
- Documenting authorization status and demonstrating proficiencies with PACE Logic system and Prime Suite Electronic Health Records.
- Appropriately schedule all specialty appointments.
- Coordinate transportation and interpretation services for all specialty appointments as needed.
- Confirm new patients and return appointments in computer system in accordance with physician and/or office guidelines.
- Provide outstanding customer service to participants and develop and maintain positive working relationships with internal and other external customers.
- Document all account activity and correspond to inquiries in a timely manner.
- Reviews Orders Tracking in Prime Suite for Orders pending authorization and scheduling on a daily basis to assure Patient Access team is meeting or exceeding all daily, weekly and monthly production goals.
- Identifies prior authorization trends and/or issues resulting in delayed processing.
- Identifies scheduling trends and/or issues resulting in delays.
- Communicates and works effectively with colleagues from other departments.
- Follows written and verbal communications.
- Follows all IIH health and safety policies and procedures.
- Follows policies and procedures to contribute to the efficiency of the company.
- Prepares correspondence, memos, forms and other typing as requested by supervisor.
- Performs other related duties as required or assigned.
Requirements
Knowledge, Skills, and Abilities
Computer Skills
• Knowledge of basic computer skills such as Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, etc.).
Language Skills
• Ability to effectively present information and respond to questions from management, participants, auditors and coworkers.
Essential Functions
• Track and schedule patient referrals
• Process authorizations
Working Conditions and Physical Demands
The working conditions and 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 access all areas of the center throughout the workday.
• Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance of another qualified employee when attempting to lift or transfer objects over 25 pounds.
Experience
• Minimum of two (2) years of experience in a scheduling, authorization and referrals health care setting, preferably in a managed care environment.
• Strong Customer Service background.
• Minimum of one (1) year of documented experience working with a frail or elderly population.
• EMR experience a plus.
• Health insurance experience and general knowledge required.
Education and Certification
• Associate’s degree or certification health administration related field preferred.
• CPR certification.
Core Values
• Respect at the core of our interactions.
• Honesty and Integrity with every endeavor.
• Patient – Centered care aligned with participant values, beliefs, and preferences.
• Encouragement that motivates and empowers others to be the best they can be.
• Quality Care that is efficient, transformative and innovative.
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