Job Description
Upward Health
Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals because we know that health requires care for the whole person. Its no wonder 98% of patients report being fully satisfied with Upward Health!
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WHY IS THIS ROLE CRITICAL?
The Care Team is a multidisciplinary team of licensed and unlicensed staff who provide direct support and care to Upward Healths patients. The Care Team is comprised of a diverse team that may include registered nurses, licensed social workers, pharmacists, therapists and paramedics, care navigators and care specialists. This team works within the community and in the patients homes or meet in agreed upon locations in the community.
The Care Navigator is responsible for ensuring a seamless patient experience as the single point of contact for the patient. The ideal candidate possesses career experiences in fast-paced provider office settings. Care Team staff are trained to provide extensive patient support and assistance. The Care Navigator offers a range of direct patient care support that includes community and medical referral aid, telephonic care coordination assistance to patients and providers, and clinical coordination across all medical and behavioral providers. Additionally, the Care Navigator assists the Care Team in utilization management.
KEY RESPONSIBILITIES:
Single point of contact Coordinate with providers and Care Team members to provide ongoing support and communication to our patients and ensure a smooth continuum of care
Monitor patient hospitalizations and follow up as necessary with Care Team staff
Provide patients with educational materials and execute correspondence to primary care physicians and specialists for new patient enrollments/appointments
Collect, verify, & coordinate clinical and administrative information (e.g., Hospitalizations, Insurance)
Patient registration Perform outbound calls to patients to understand their clinical needs and connect them with appropriate resources
Collect, enter, and/or confirm patient demographic, health, insurance, and payment information in EHR and related systems
Help patients register for and access the EHR patient portal
Explain Upward Healths payment policy to patient
Facilitate completion of new patient forms
Insurance verification and authorization fulfillment Verify patient insurance information using insurance card and payers portals
Contact payers for out-of-network inquires and to determine coverage policies
Identify patient cost-sharing amount and enter in EHR and related systems
Identify and complete prior authorizations for services and medications
Monitor insurance changes and identify/research established patients who lose eligibility
Scheduling & check-in Ensure that patient appointments with Upward Health providers are scheduled promptly and efficiently
Manage patient appointment cancelation and rescheduling as needed
Ensure patient missed appointments are rescheduled and communicated to the physician/clinician, patient, and members of the Care Team
Maintain system of notifications sent to patients about scheduled appointments
Attach any pre-visit paperwork to the patients EHR chart
Ensure completion of as-needed patient clinical and administrative forms ahead of visits
Contact patient in advance of or at beginning of appointment to complete check-in and: Confirm demographic information
Confirm patient insurance eligibility
Review patient account balance and any co-payments due
Collect payment information from patients, including processing credit card payments for patient cost-sharing amounts
Notify patients of necessary future appointment details
Provide minor technical assistance to ensure that patients can access virtual visits
Follow Up Support from Provider Visits Assistant the providers delivering care as it relates to pre and post visit documentation, following up on orders, faxes, and labs, and ensuring smooth experience for patient and provider
Perform outbound calls to providers to make appointment for patients or follow up on care
Follow up with patients to ensure their needs are met and schedule future wellness discussions
Expedite follow up to further coordinate next steps as to the patient response, scheduling needs and insurance coordination
Various administrative support and other duties Lead the answering of the phone and responding to the fax machine for patient inquires
Answer inbound calls from patients, providers, and Upward Health resources as necessary
Collaborate with Finance colleagues on patient billing issues
Handle medical record requests
Manage the incoming queue of patient referrals
Prepare reports and documents as needed or requested, ensures Care Team is following proper documentation protocols at the direction of the Manager
Attend regular team meetings and participate in clinical rounds
Maintain patient, provider, & payer contact & referral Information
Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES:
Interpersonal savvy, with the demonstrated by the ability to interact with and influence people to establish trust and build strong relationships
Practice an extreme sense of urgency and can-do attitude required for a role at a start-up company
Strong organizational skills and ability to juggle multiple high-priority tasks and maintain a personal schedule
Strong attention to detail to ensure that work is completed accurately and completely
Ability to establish priorities and meet deadlines
Flexibility to change course and take on additional responsibilities as the business requires
Ability to work independently within a virtual operating environment and as part of a team
Excellent oral and written communication skills
Ability to exercise judgment in the application of professional services
Comfortable with computer data entry
Multi-lingual capabilities preferred, but not required
QUALIFICATIONS:
3+ years at an outpatient healthcare practice serving as a patient representative or similar experience
High school graduate or GED required
Prior experience in health insurance and medical terminology is preferred
Knowledge of community resources in applicable geographic area
Able to maintain clear professional boundaries with members and coworkers
Cultural competency able to work with diverse groups of community members
Highly technologically savvy
Report development from clinical and non-clinical systems
Ability to assist with development and distribution of educational materials
Upward Health is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce.
This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.
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