Health Plan Coordinator (Internal Medicine) -30110
Company: Tuality Healthcare
Posted on: May 3, 2021
The Health Plan Coordinator is responsible for maintaining
patient referral and authorization requirement needs through
guidelines established by the patient's individual insurance
The work environment is a combination of multi-line telephone
use, insurance hub, receptionist and scheduling coordination. It
could involve assisting with the check-in and checkout processes.
Gathers and records required information about referrals and
authorizations for services, and routes it appropriately; provides
specific customer services which include, confirming health
insurance coverage and individuals obligations, obtaining necessary
authorizations for care, scheduling appointments or procedures, and
assisting patients in an office or clinic setting.Requires out of
the box thinking, strong ability to multi-task and above all else,
exceptional customer service skills.
Performed majority of the time -- please start with the
responsibilities that are the most time consuming:
- Processes referrals and authorizations as indicated by the
various insurance plans, for consultations, studies and
- Obtains authorization for medications with insurance companies
as needed, both prescription and infusion medications.
- If applicable, coordinates the sample medication program within
the clinic which includes: receiving medication, updating and
reconciling the medication log, providing appropriate drug
documentation to providers (MD's should be providing this with med
to patient), and ensure appropriate inventory levels for samples.
Position will also oversee the medication storage within the clinic
which includes ensuring medications are stored in a secured fashion
and not accessible to anyone not authorized to handle medications,
oversee temperature settings for medication fridge, and will work
with pharmacy to conduct monthly medication management
- Works with patients to find co pay and drug assistance.
- Prepares and routes medical information to third parties and
referral physicians with proper authorization and notation.
- Maintains appropriate notations and copies of documents in
- Responds to requests for status of referrals.
- Verifies insurance eligibility for physician visits.
- Answers and follows-up on telephone inquiries; directs callers
to other providers, staff or departments when appropriate. Triages
and documents accurately telephone calls from patients including
requests for medication refills, complaints, general information
inquiries, and urgent health care concerns. Delivers such
information or requests promptly to the appropriate providers or
- Obtains prior medical records and studies as appropriate
- Updates demographic records for patients, entering all
information from patients directly into computer in a concise and
- Updates financial record for customers, entering all
information from patients directly into computer in a concise and
professional manner regarding patient concerns, questions and
agreements regarding their bill statements, payments and insurance
- Responds to correspondence as appropriate, by phone or in
- Collects, sorts and distributes mail daily.
- Responds to correspondence as appropriate, by telephone and/or
- Maintains an organized work area.
Performed occasionally but critical to successful performance of
- Checks in patients to include gathering patient information,
entering into computer, collecting co-payments, creating new charts
and handles insurance information appropriately.
- Checks out patients to include addressing any additional
patient concerns or needs.
- Schedules patient correctly through EMR and within provider
- Attends monthly full staff meeting.
- Communicates supply needs in a timely manner to the ordering
- Attends insurance workshops and reads insurance updates.
- Completes all mandatory education and licensure requirements to
meet state, professional and regulatory requirements.
Decision making and budget responsibilities (e.g. impact limited
to the employee, entire unit or organization-wide):
- Impact limited to the employee.
- No budget responsibility.
Assigned direct reports (not limited to the ones listed). If not
applicable, please enter N/A:
- High school graduate or GED.
Licenses, Certifications and/or Registrations:
- Current BLS certification.
Job Related Skills, Abilities and Behaviors:
- Demonstrates professional appearance and personal conduct for
the employee's particular job.
- Uses effective communication skills taking into consideration
body language, filters, listening, paraphrasing, and questions with
customers of diverse ethnic and cultural backgrounds.
- Excellent grammar, spelling and mathematics abilities.
- Demonstrates excellent telephone skills and customer service
- Demonstrates effective organization skills and ability to
multitask with frequent interruptions.
- Demonstrates working knowledge and understanding of medical
terminology and insurance authorization processes, CPT and ICD-10
CM coding methodology.
- Demonstrates knowledge of managed care insurance plan
- Understands and applies insurance coverage pertaining to
- Demonstrates personal computer skills including working
knowledge of Word and Excel programs.
- Demonstrates confidentiality in dealing with patients, patient
families and co-workers.
- Models effective working relationships with all health care and
insurance plan representatives.
- Practices confidentiality regarding staff, department and
- Bilingual in Spanish and English.
OHSU Health Hillsboro Medical Center, formerly Tuality
Healthcare has always been committed to our community. It's a part
of how we care for each other, and part of what makes this place
We had a humble start in 1918 when an enterprising woman named
Minnie Jones Coy started a small six-bed hospital in her Hillsboro
home. She brought together independent physicians under one roof to
treat the sick and provide a safe place for mothers to give birth.
A century after Minnie made her commitment to the people of
Hillsboro, her vision continues as we provide world-class health
care to patients.
As part of our affiliation with OHSU Health, we've changed our
name to Hillsboro Medical Center. This new moniker reflects our
expanded services and clinic locations that provide patients living
in Hillsboro and western Washington County greater access to
primary and specialty care.
Additional Posting Information
Hillsboro Medical Center believes in providing equal employment
opportunities for all qualified individuals. Recruitment, hiring,
promotions, transfers, working conditions, training, and
compensation will be based on qualifications without regard to
race, color, sex, sexual orientation, gender identity, religion,
age, creed, national origin, marital status, family relationship,
veteran status, genetic information, physical or mental disability,
or any other status or characteristic protected by applicable law.
We further commit ourselves to continuing the practical application
of this policy in our daily business conduct.
Keywords: Tuality Healthcare, Hillsboro , Health Plan Coordinator (Internal Medicine) -30110, Other , Hillsboro, Oregon
Didn't find what you're looking for? Search again!