Position Summary:

The Complex Service Coordinator is responsible for resolving delays in the delivery of care, equipment or services related to home health, DME/supplies and pharmacy/infusion. The Complex Service Coordinator will work with critical stakeholders including network and owned providers and utilize critical thinking and problem-solving skills to resolve issues that create delays of service.

What to expect in your role:

• Identify appropriate Home Health agency providers to staff cases with appropriate discipline and services
• Coordinate services and care per contractual arrangements with network providers
• Address and assist in resolving issues related to benefits, insurance, and billing
• Investigate and resolve any issues or concerns that impede timely delivery of ordered equipment or services
• Perform appropriate triage and escalation of urgent issues to the network team when appropriate
• Consult with supervisor or Manager on complex and unusual problems
• Communicate to providers to notify and resolve any issues or barriers that create a delay of service to the patient
• Provide an excellent member experience through timely and direct communication in inbound and outbound calls
• Provide referral education to members and providers regarding medical benefits, referral status and prior authorizations
• Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, Home Care and DME regarding referred services
• Develop and maintain effective working relationships with referring entities and network providers
• Manage communication and correspondence with referring entities, insurance companies, providers and internal customers as required
• Maintain detailed documentation to record patient, physician, referral source and provider interactions and communications
• Maintain working knowledge of applicable CPT, HCPC, and ICD-10 codes
• Maintain working knowledge of all insurance contracts
• Understand Medicare/Medicaid criteria and Health Plan policies to ensure the referral meets all requirements and guidelines
• Preserve the security and confidentiality of patients’ personal information at all times
• Maintain a working knowledge of, and adhere to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA
• Report ongoing issues with referring entities or providers that delay service delivery to manager
• Provide excellent internal and external customer service by ensuring work meets quality standards
  

What you need to succeed:

• Proficiency in English (verbal and written)
• Bilingual Mandatory
• Excellent communication skills
• Employ strong prioritization skills and a sense of urgency
• Ability to maintain composure when faced with highly stressful situation
• Ability to make decisions that adhere to policy or operational guideline using basic critical thinking skills
• Possesses the ability to handle multiple tasks at the same time
• Dependable with customer service mindset
• High School graduate or equivalent
• Knowledge of medical terminology
• Knowledge of Medicare/Medicaid & commercial/private insurance benefits, medical authorizations/billing preferred
• 1-3 years Healthcare, DME or medical industry experience
  

What we offer to you:

“We care for our employees as much as we care for our patients, which is why we offer a comprehensive benefits package, generous PTO, and employee wellness programs.”

Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.