Purpose Statement / Position Summary Under the direction of the Executive Director of Accountable Care Organization (ACO), the ACO Care Coordinator serves as a resource and liaison to ACO patients, physician practices, case managers and the health plan. The ACO Care Coordinator will assist patients in their understanding of provider options, coverage benefits, the financial impact of care decisions, and direct patients to the Nurse Care Manager, Social Worker or other clinical programs that would benefit the patient.
Essential Functions and Responsibilities of the Job
Ability to communicate both verbally and in writing
Ability to complete work independently and collaborate with internal and external team members and participate in ACO and/or related meetings, committees or functions
Ability to understand medical terminology or concepts
Computer literacy with ability to work within several internal and external on line and Web based systems, reports and analytics, including Microsoft Office (Word, Excel, power point)
Ability to use basic math skills
Understanding of privacy and HIPAA standards
Essential Job Outcomes
Runs reports to identify patients for contact and open encounters to facilitate the documentation of the contact.
Manage, maintain and coordinate technical activity around ACO FTP and file extraction for action.
Patient outreach using compassionate customer service with the goal to inform the patient of care gaps and facilitate getting care gaps closed.
Review reports to identify patients with care gaps and risk stratify the members for care management assignment.
Works collaboratively with the ACO Case Management Team, Network Management, and the physician offices to ensure patients’ experience and outcomes are optimized.
Holds a general understanding of complex payment methodologies when researching benefit issues and sharing findings to patients and providers.
Assists in the distribution of educational materials to the provider’s offices, such as tool kits, ACO network provider cost and quality data.
Detail oriented with continual attention to optimize efficiencies in the development of solutions for provider offices who identify, care for, and engage ACO patients.
Develops reports/graphs/analysis/minutes and agenda for workstreams and team meetings.
Refers members to and collaborates with appropriate ACO Health Plan retained functions in Case Management including; Transplant, Transgender Reassignment Surgery, Bariatric Surgery, Complex Newborn/NICU, Eliza (IVR Warm Transfer), Behavioral Health, Investigational/Experiment services, Benefit Substitution Period, Out of ACO Service Area
“Other duties as assigned”
A minimum of three (3) years of Managed Care related experience with a strong understanding of Memorial Health Systems operations, HMO and PPO health plans, health care benefit designs, claims, physician office practice operations, medical terminology and or equivalent combination of education and experience
Previous ACO Program experience preferred
Associate degree (A.A.) or equivalent from a two (2) year college or technical school preferred
Medical background required; Medical Program or Certification preferred
Internal Number: MEM003279
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