Practice CRD 3

As a patient-focused organization, UCSF Medical Center exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. UCSF Medical Center seeks faculty and staff that are committed to the values of professionalism, respect, integrity, diversity, and excellence that are integral to our mission.

Under supervision of the Practice Supervisor, guided by policies and procedures of the Ambulatory Services, the Practice Coordinator 3 is primarily responsible for representing the administrative team as the public face of the Practice and works closely with the administrative, clinical and management teams to support practice operations and customer service recovery and intervention efforts. S/he provides support to all functions of the administrative teams including but not limited to: CRM messages, telephone encounters, referrals, APeX in-baskets, scanning, filing, authorizations, and billing.

The PC 3 is responsible for the maintenance of all routine clerical operations and communications. S/he adheres to the UCSF House and Telephone Standards and is sensitive to the needs of patients, staff and providers at all times. The PC 3 is a team player who works closely with others and who is flexible in dealing with the changing priorities.

S/he is a self-reliant individual who synthesizes his/her knowledge of practice operations in order to problem-solve, prioritize and facilitate complex transactions in the course of his/her daily activities. The PC 3 provides excellent customer service, facilitating and ensuring the accuracy of the information flow between medical, hospital staff and departments to maximize unit efficiency. The PC 3 is required to work at any UCSF campus as needed and scheduled.

• Day shift Responsibilities Advanced New Patient Scheduling and Coordination ___10____ % Secures outside medical records, CD’s of scans and pathology slides; reviewing them for completeness; and making a determination as to which physician can best evaluate the patient. Understands and is able to prioritize new patient scheduling based on diagnosis and current treatment status to ensure complex patients are scheduled according to practice priorities (e.g. someone newly diagnosed with Stage IV colorectal cancer is seen within the week vs. a second opinion currently receiving treatment is seen within 3 weeks). Informs patients about possible treatment scheduling options, clinical trials and screening is coordinated with appropriate research personnel and the appropriate physician. As indicated upon screening, if the patient would benefit from a consultation with other clinical disciplines consults with the appropriate department and will work to coordinate care, to optimize schedules, and expedite services. At new patient visits, as appropriate meets with patient after the visit to explain how care is coordinated with possible clinical trials, testing, surgical procedures and care within other departments (e.g. general surgery, cardiology) and with other external providers. Advanced Surgery Scheduling __0____ % Coordinates pre-operative anesthesia appointments with other testing, authorization coding and scheduling the surgery in Op
• Time. Additionally, many cases require complex admission, discharge and planning coordination involving hospital reservations and authorizations related to study patients on protocol, transfers from outside hospitals and post transfer urgent authorizations and surgical planning. Works with patients and staff to confirm availability and accuracy of medical information within APeX and to ensure compliance with all hospital policies and procedures. Secures authorization for surgical procedures and coordinates with Hospital Admissions Department as needed. Communicates with the surgeon post-surgery to confirm if any additional surgical procedure was performed and if so to follow up with the insurance company immediately to amend the authorization. Acts as primary liaison to procedure billing team to coordinate updated authorizations and or TARs for mid procedure changes or additions. Ensures compliance with Medical Center bylaws and Regulations ensuring the diagnosis is confirmed before treatment is offered through formal review of any and all outside studies and pathology. The coordinator is the sole person to ensure appropriate and timely communication and documentation with the patient and the physician. Successfully interacts with patients to secure surgical consent for cosmetic services. This includes identification of cases, cosmetic price guidelines, quote prices and coordinate payment. Analyze the pricing structure to ensure that the prices remain competitive and are updated as needed. This position is expected to represent UCSF Medical Center’s objective to grow elective cosmetic services by providing sophisticated customer service and sales Arranging post-surgical appointments and testing, which may or may not include Home Care, Physical Therapy, starting paperwork for durable medical equipment and following up on all other paper work, i.e. Workers Compensation as necessary Advanced Revenue Cycle ___10____ % Secures complex insurance authorizations for services, medications, or testing and is able to track the authorizations for renewal based on insurance company driven limits of time frames or numbers of visits or services. Has demonstrated competency working with HCPC codes and is able to look up and locate the appropriate codes for the purpose of requesting authorization (e.g. J codes for medications like chemotherapy). Understands how to identify and interpret a patient’s insurance benefit package, including pharmacy and mental health carve outs. Utilizes this information to direct authorization requests and to coordinate these services for patients. Reviews & analyses monthly denial reports for both professional and hospital billing. Initiatives retro authorizations from denial report. Identifies trends in denials and works with practice team and supervisors to develop and implement improved workflows to minimize denials. Compiles & analyzes data for reports to track basic revenue cycle measurements such as charges, payments, visit volume, etc. and creates reports in Microsoft Excel. Oversees and coaches staff on complex authorization requests as they arise. Address patient complaints from patients regarding billing and complaints related to billing that come out of Patient Relations. Through reporting track patterns of billing complaints and identify patterns which can be addressed with coaching and education of staff and providers. Understands the concept of managed care and is knowledgeable about the resources available to the staff in regards to knowing the specific requirements of individual managed care plans. Assists patients to understand the concept of managed care. Reviews all upcoming visits to determine patient eligibility and assists with transitioning patients who are no longer eligible to new primary care practices through collaboration with the practice Social Worker and clinical teams. Department resource for insurance questions and insurance updates, including having reserved time on the staff agenda to review updates with administrative team, include important updates in the practice newsletter including drafting newsletter announcements As practice SuperUser will produce reports and review with staff cash collection barriers to improve cash collection rates for the practice. Advanced Check in/ Front Desk: _____5___% Responsible for front end office responsibilities to include but not limited to functions ranging from registration and front desk duties, referral processing, authorization coordination and review, cash deposits, DME oversight and scheduling functions. S/he will also act as a Care Support Assistant for the Delivery System Reform Incentive Payment (DSRIP) funded clinical team. Develops and analyzes front desk productivity reports in partnership with the management team to improve co-pay collection rates and accurate payer plan capture. Identifies opportunities for productivity improvement and assists management team with staff coaching and workflow enhancement. Is primarily responsible for representing the clerical team as the public face and works closely with the administrative and management teams to support practice operations and customer service recovery and intervention efforts. S/he provides support to all functions of the administrative teams to include: message boards, referrals, Apex in-baskets, scanning and filing. Cadence Template Builder ____5_____% Able to create Cadence schedule templates for providers Understands how template construction effects access and works to ensure templates is user friendly and help promote consistent clinic access. Able to generate reschedule reports in Cadence and work with other members of administrative team to ensure patients are rescheduled in a timely manner to avoid customer service problems. Advanced Administrative and Patient Care Coordination Responsibilities __25_____ % Acts as liaison with Concierge Services. Expedites requested services. Coordinates complex patient care coordination activities. Arranging appointments and testing, which may or may not include Tumor block genetic testing, Home Care, Physical Therapy, starting paperwork for durable medical equipment or disability paperwork and following up on all other paper work, i.e. Workers Compensation as necessary. Keeps track of patients who have parallel pathways for their medical care and works with clinical providers to take steps at critical points along the continuum. May create and maintain APeX patient lists or Excel Spreadsheets for tracking purposes. For example, patients receiving neoadjavent chemotherapy who will be scheduled for surgery once their tumor has shrunk and must be evaluated by the MD after cycle 3 of their chemotherapy regimen. The PA IV will need to keep track of the patient and schedule a timely appointment with the surgeon and the medical oncologist to coordinate planning for surgery scheduling. Is skilled and able to book Radiology appointments directly into Radiology scheduling software while ensuring accuracy of exam types, location specifications and insurance restrictions. Identify referral problems; report out to management team with suggested solutions. Develop and review reports related to referral management, tracking and updating management team with ongoing outgoing and incoming referral issues as they arise. Oversight with maintaining Open Access schedules in order to meet the Patient
• Centered Medical Home (PCMH) standards (could include Direct Access scheduling into the generic job template) Pend orders (including med refills, referrals, procedures etc.) associate with a diagnosis and route to provider for review and signature (from preference list only) Pend Smart Sets with proper orders and diagnosis and route to provider for review and signature Modify order class of labs from lab collection vs. clinic collection or UCSF Collect vs. External Collect. Perform advanced appointment scheduling using complex scheduling protocols from a variety of ancillary and subspecialty services some of which will require authorization. Support Patient
• Centered Medical Home, Standard 1 guidelines that require patients have daily available appointment access to the practice and if no appointments are available coordinate them at another site or within Adult or Pediatric Urgent Care. Responds to telephone calls from patients seeking medical care at UCSF Medical Center. Utilizes the EPIC Appointment Scheduling System (Cadence) to schedule patient appointments in accordance with practice policy. Documents call information in the EPIC CRM in a concise, accurate manner. Is able to convert CRM messages to telephone encounters according to practice guidelines and workflows Responds to patient’s online Web appointment requests for patients utilizing the online appointment system. Utilizes Phone Bank protocols to determine when to involve a clinician on a call due to urgent or emergent symptomatology. Moderate Complex APeX and IT Specific Skills ___5____ % Phone Bank ___5____% Moderate Complex General Performance ____5___ % Maintains provider calendars When working in a primary care practice, assists with the delivery and maintenance of a high standard of patient care using the Patient Centered Medical Home model which emphasizes the care of the “whole patient” which includes in-reach, outreach and intensive follow up on referrals. When working within the primary care environment acts as the coordinator for all of patient’s needs such as forms (ie. work release, disability, immunization records, etc.) and is principally responsible for the continuity of care for patients which includes a significant amount of support for patients at the time of the visit and between visits. Provides 1:1 and team training for new hires and new initiatives and procedures Facilitates Float coverage as needed for practice (e.g. when float is assigned, work with float to ensure successful coverage of work) Serves on and contributes documentation to the Patient Centered Medical Home application workgroup Advanced General Performance ___15__ % Environmental

_______5__ % Reports any malfunctioning of equipment. Complies with recommendations made by ergonomic specialists to avoid workplace injury Complies with infection control policies related (e.g. does not eat at the front desk or in patient care areas) Serves as practice deputy for life / safety activities helps lead drills Moderate Complex Environmental Responsibilities ____5___ % Customer S Required Qualifications High School graduate or equivalent with four years related experience; or college degree and 6 months related experience; or equivalent combination of education and experience.

Successfully passes fingerprinting protocol and is approved to be a cash collector Strong computer skills, including basic keyboarding skills, and experience with at least two Office-type software programs (i.e., Outlook, Word and Excel). Proven ability to navigate through multiple patient records systems. Able to sit at a computer terminal with telephone headphones for extended period of time.

Ability to analyze situations, prioritizes, and develops solutions and makes recommendations. Ability to work with minimal supervision Ability to use good judgment and work independently, at times under the pressure of deadlines Ability to access situations prioritizes workload, develop solutions and make recommendations. Excellent customer service and communication/interpersonal skills, both over the telephone and directly.

Able to sit at a computer terminal with telephone headphones for extended periods of time. Basic math skills required. Proven ability to deal with a wide variety of individuals; Ability to deal sensitively and effectively with patients.

Excellent organizational and problem-solving skills. Strong writing skills to include the ability to compose, edit, and proof a wide variety of documents. Demonstrated administrative/office coordination skills.

Demonstrated knowledge of medical practice terminology. Within six months of start date, based upon completion of training, the Supervisor, completes the proficiency checklist with the employee. This includes the following areas if applicable Referrals (Incoming referral entry) and handling all referral WQs Pend orders Pend smart sets Schedule surgeries Work applicable work queues Enter/edit outside test results Messaging (CRM) if applicable 2nd calls in CRM if applicable Telephone encounters My open encounter Staff message New message Route Patient advice request to providers (My Chart) Patient Schedule (My Chart) Letters Pools Patient look up Check in process Check out process Comment field Quick note Scanning

Demonstrated experience in health care (may include medical, dental or veterinary) in the following areas: patient scheduling, insurance verification, medical record data abstraction, or patient financial services. Prior experience with appointment, ancillary service or surgical scheduling or a combination of all three. Bi-lingual or multi-lingual capability (Spanish, Cantonese, and Russian) strongly preferred.

Prior experience with EPIC.