General Information
| Job Description | AMBUL CARE ADMSTN CRD 2 | Working Title | Provider Program Coordinator |
|---|---|---|---|
| Job Code | 004176 | Grade | 19 |
| Department Name | Clinical Affairs - D02007 | Department Head | Donald Larsen |
| Supervisor | Krystal Rivas | Effective Date | 07/24/2022 |
Position(s) Directly Supervised
| Job Code | Title | FTE |
|---|
Generic Scope
| Professional who applies acquired job skills, policies, and procedures to complete substantive assignments/projects/tasks of moderate scope and complexity; exercises judgment within defined guidelines and practices to determine appropriate action. |
Custom Scope
| Applies acquired skills and clinical and operational knowledge of ambulatory care clinics to coordinate aspects of clinic operations of intermediate scope and complexity. Monitors daily clerical activities, billing, and other operational services for a clinic in the medical center. |
Department Custom Scope
| Under the general supervision of the ambulatory operations director, the provider program coordinator is responsible for supporting the administrative needs of the UCR School of Medicine faculty/physician practices to ensure maximum utilization of resources and efficient delivery outcomes. Responsible for coordinating operations of the designated site program will work closely and collaboratively with UCR Health providers. Coordinate and manage provider caseload in collaboration with the patient care team to ensure appropriate and timely admissions and discharges. Support the program by coordinating and participating in the development of physician policies and procedures, inter and intradepartmental relationships, internal and external physician and provider communications and other task to maintain quality patient care and positive experience. The incumbent must have the ability to perform and prioritize multiple tasks and work well with internal and external resources. Ensure compliance with regulatory requirements and revenue cycle activities by guiding timely completion of medical records and charge capture; supports and participates in clinical documentation initiatives. For assigned sites, responsible for the UCR Health provider schedule and day to day staffing and forecasts need to support effective and efficient operations while maintaining maximum labor productivity. Monitors the financial performance of the program and seeks opportunity for improvement; ensure timely renewal of licenses and certifications. Please note: Job requires occasional local travel between UCR sites. |
Education & Experience Requirements
Education Requirements
| Degree | Requirement |
|---|---|
| Bachelor's degree in related area and/or equivalent experience/training. | Required |
Experience Requirements
| Experience | Requirement |
|---|---|
| Minimum of 2 years of related experience. | Required |
| 2 - 4 years of related experience. | Required |
| The two years of experience must include clinical operations setting, practice management, healthcare billing environment, third party payor networks/managed care, and/or healthcare coding/clinical documentation. | Required |
| Prior experience working with healthcare quality measure data. | Preferred |
| Prior experience working in healthcare within an academic setting. | Preferred |
License Requirements
| License | Requirement |
|---|---|
| Valid Driver License | Required |
Certification Requirements
| Certification | Requirement |
|---|
Educational Condition Requirements
| Condition | Requirement |
|---|---|
| A total of six years of related experience can substitute for the bachelor degree. | Required |
Key Responsibilities
| Description | % Time |
|---|---|
Coordinates daily clinic activities and monitors workflow of administrative services including patient registration and authorization, referral coordination, medical records storage and maintenance. Oversees staff performance ensuring compliance with policies and regulations.
|
25 |
Serves as department resource for finance and compliance questions/issues.
Serves as a liaison between academic and clinical groups.
|
15 |
Monitors daily clinical reporting, communicates results to provide accurate and timely patient care coordination.
|
15 |
Maintains patient accounts, interacts with collection agencies , and negotiates patient payment plans. Serves as liaison with billing office.
|
10 |
Troubleshoots day-to-day administrative and IT issues. Handles escalated issues seeking clinical input when appropriate.
|
5 |
| Performs clinic revenue reconciliation. Compiles and reports reimbursement data. Assists with incident reporting. | 5 |
| Conducts chart reviews and reports discrepancies. Updates diagnosis and procedure codes to support clinical documentation and maximize reimbursement. | 5 |
| Coordinates conferences, compiles attendee conference notes and clinical recommendations and disseminates information. | 5 |
| Requests certificates of insurance. Sets up and maintains provider information in online databases and system; tracks license and certification expirations for all providers to ensure timely renewals. Maintains confidentiality of provider information; provides credentialing and privileging verifications. | 5 |
| Travel to other UCR and affiliate sites. Supports other clinical practice locations. | 5 |
| Special projects and other duties related to the clinical enterprise as assigned. | 5 |
Knowledge, Skills & Abilities
| Knowledge/Skill/Ability | Requirement |
|---|---|
| Ability to perform all commonly applicable functions in word processing and spreadsheet software. Skills in data management. Ability to use relevant healthcare and clinic operations information technology, including billing systems and medical record documentation. | Required |
| Strong communication skills; includes verbal, written and active listening. Ability to clearly and concisely communicate clinic rules and regulations. | Required |
| Proven organizational skills and the ability to effectively manage time and prioritize tasks. Takes initiative. Ability to meet tight deadlines and manage several projects simultaneously, respond rapidly to conflicting priorities, and handle tasks with high degree of accuracy. | Required |
| Working knowledge of medical center policies and procedures and related legislative, accreditation, licensing and compliance environments. | Required |
| Data analysis, research and reporting skills. | Required |
| Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations. | Required |
| Demonstrated interpersonal skills with diverse staff and patients. Demonstrated ability to develop working relationships within clinical team. | Required |
| Familiarity of clinic medical billing practices including coding, billing systems and documentation requirements. Knowledge of ambulatory care clinic practice management including patient care workflows and processes. Demonstrated understanding of medical terminology and clinical knowledge of clinic practice area. | Preferred |
Special Requirements & Conditions
| Special Condition | Requirement |
|---|---|
| Must possess or obtain a Valid CA Drivers License and insuring a motor vehicle in accordance with the California Department of Motor Vehicles if driving for university related business. | Required |
| Travel | Required |
Other Special Requirements & Conditions
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Level of Supervision Received
| Supervision |
Environment
Working Environment
| Healthcare (hospital/clinic) and office settings. |
Other Requirements
Items Used
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Physical Requirements
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Mental Requirements
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Environmental Requirements
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Critical Position
| Is Critical Position: Yes |