POSITION SUMMARY: The Care Coordination Associate (CCA) organizes and manages health information data by ensuring its quality, accuracy, accessibility, and security in both paper and electronic systems. Maintains the Electronic Health Record (EHR) and ensures that client information is entered and updated in a timely manner. Schedules client appointments and ensures that medical records are appropriately routed to physicians, emergency departments, hospitals, and other health care providers. Ensures that all data exchange meets the legal requirements of Health Insurance Portability and Accountability Act (HIPAA) and protects client rights.

DUTIES & RESPONSIBILITIES:

• Responds promptly and professionally to all forms of communication including but not limited to phone calls, email, fax, e-HR notifications regarding medical appointments and care coordination to ensure continuity of care
• Verifies client insurance eligibility based on insurance eligibility documentation routinely as they schedule appointments by reviewing and utilizing the electronic health records; contacts insurance carriers as needed to ensure appropriate care can be secured
• Updates and monitors electronic health records system to ensure compliance of all medical appointments
• Acquires insurance referrals and pre-authorizations as needed from the carrier for appointments to be scheduled requesting assistance from Nurse Case Managers and Program leads as needed to ensure continuity of care
• Obtains necessary paperwork for durable medical equipment as required for payment by the insurance provider including but not limited to obtaining the prescription, any pertinent information from a Primary Care Physician (PCP) or hospital; follow-up with insurance provider as needed to ensure care continuum
• Prepares reports relative to regulatory standards by ensuring required medical/dental/lab appointment reports are collected and maintained, such as Primary Care Physician (PCP) visits, lab testing and results, emergency department visits, hospitalizations, and required health maintenance visits to ensure care coordination; presents reports to the direct supervisor for system compliance review
• Tracks medical appointments and labs for assigned caseload by running status reports within electronic health records to ensure that all required and recommended medical follow up appointments, treatments and diagnostic studies are scheduled and completed within the allotted regulatory timelines
• Tracks medical documentation of all encounters with medical providers for assigned caseload to ensure that the associated documentation reaches the responsible staff and that they are aware of the requested follow up for continuity of care
• Supports the program to ensure the individual and staff are prepared for individual medical appointments for their assigned caseload with tasks including but not limited to validating insurance information prior to the visit, confirming that all necessary pretesting (laboratory tests, x-rays, diagnostic studies, etc.) has been performed and results received and forwarded, ensuring that the Medical Appointment Summary form is initialized for each visit and compiling the packet of required paperwork for the visit and providing to the site supervisor
• Schedules medical appointments with PCP, specialists, and other applicable allied health professionals based on the program medical appointment schedule, requests from a nurse or program manager, or a previous Medical Appointment Summary reflecting the physician's note to ensure the ongoing health and safety of each individual
• Obtains consultative, diagnostic, and other clinical reports and submits to the assigned nurse and other health care providers on the clinical team to ensure continuity of care, identification of additional healthcare and other needs
• Performs other work as assigned

IMMEDIATE SUPERVISOR: Executive Director, Healthcare Services

DIRECT REPORTS: None

CONTACTS: Elwyn personnel; clients; families/guardians; physicians; other health care providers; insurance carriers; services and agencies such as pharmacies, hospitals, skilled nursing facilities, and hospice programs

EDUCATION/ EXPERIENCE/SKILLS REQUIREMENTS:

• Associate degree in Human Services, or a healthcare related field preferred; high school diploma or graduate equivalency diploma (GED)
• Experience in a large multi-specialty physician practice or healthcare setting preferred
• Possess working knowledge of medical terminology and basic clinical knowledge such as International Classification of Diseases (ICD-coding), Diagnostic and Statistical Manual of Mental Disorders (DSM)
• Knowledge of medical insurance coverage plans preferred
• Intermediate experience in the use of standard Microsoft Office Word, Excel, Outlook and Teams (or other virtual meeting applications, e.g., Zoom, etc.)
• Demonstrated skills in the use of the EHR, including, maintenance and reporting capabilities.
• Excellent planning, organizational, and written and spoken communication skills
• Possesses strong customer service orientation, the ability to multitask, and close attention to detail
• Ability to work in a fast-paced environment and manage and prioritize multiple, often competing priorities
• Ability to request, accept and utilize feedback and training appropriately
• Ability to provide effective feedback, train and delegate job assignments
• Demonstrated commitment to standards of excellence that demonstrate an overall concern for quality of work, communication, and commitment to doing what is best for the organization
• Demonstrated ability to work as an efficient and effective member of a team
• Must have current, valid driver's license in state of residence, three (3) years driving experience in the United States, and acceptable driving record

PHYSICAL DEMANDS/ENVIRONMENTAL PROFILE: See Physical Demands Checklist below which represents the general physical demands and environment conditions to which the employee holding this position must meet, in addition to the duties and responsibilities listed above, to successfully perform the essential functions of this job. Elwyn will engage otherwise qualified candidates for this position whose disabilities may require reasonable accommodations to enable an individual to perform the essential functions.

Elwyn reserves the right to revise or change job duties and responsibilities as needed. This job description is not intended to be an all-inclusive statement of duties and responsibilities of the job nor does it constitute a written or implied contract.

Elwyn is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation and identity, gender identity, national origin, citizenship status, genetic information, disability status, military or veteran status, marital or family status, political activities or affiliations, or any other characteristic protected by local, state, and federal law.