Value Based Program Clinical Specialist (Medical Assistant Required)
This position will serve as a key support between Adelante Healthcare and the patient population as attributed through Value Based Contracts with all lines of Business under the Value Based leadership. The person in the position will develop and maintain strong relationships with our patients and help schedule patients for care and be responsible for achieving the team based and individual goals as outlined for the Value Based Care team. The Value Based Program Clinical Specialist will help support patients and increase engagement, overcome barriers and act as additional support to our provider teams and work to achieve the Value Based incentives as outlined in Adelante’s contracts. In addition, this position also helps address and close gaps in care and other care coordination efforts for a patient centric experience.
Every Adelante employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism, and competence.
OUR CORE VALUES
ESSENTIAL SKILLS AND EXPERIENCE
- Two (2) or more years’ experience in a clinical setting
- High school diploma or GED from an accredited institution
- Graduation from an accredited medical assistant program
- Certification to perform cardiopulmonary Resuscitation for the Health Care Professional (CPR) and AED through courses that follow the guidelines from the American Heart Association and Red Cross (cognitive and skills evaluations)
- Demonstrated understanding of clinical methods and techniques used in record keeping systems
- Demonstrates continuous attention to detail
- Effective communication demonstrated by ability to read, interpret, comprehend and comply with written and verbal communication
- Ability to communicate effectively with patients, co-workers, and our communities both in person and over the phone
- Ability to multi-task and work effectively in a high-stress and fast-moving environment
- Exceptional customer service, communication skills, problem solving and organizational skills
- Previous call center experience strongly preferred
- Strong computer efficiency in Microsoft Office suite (Word, Excel, PowerPoint, Outlook) and experience in Electronic Healthcare Records (EMR)
- Works independently to meet deliverables and performs a variety of assignments requiring independent judgment.
- Provides and accepts support in a collaborative manner
- Able to meet the organization’s immunization requirements
NONESSENTIAL SKILLS AND EXPERIENCE
- Bilingual (Spanish/English preferred)
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
- Participates in Value Based Care team meetings and improvement initiatives, staff meetings, in-service meetings, or other required meetings
- Engages patients and promotes health care gaps compliance through health and disease patient education
- Extensive Outreach efforts for well visits, high-risk patients, preventative screenings, and/or other populations as needed.
- Obtains patient records through various sources such as external portals or using our internal medical record request process.
- Reconcile medical records to and from the Electronic Health Record to ensure patient data is up to date within our EHR and the insurance provider.
- Ensures that patient documentation is available for uploads to reflect accuracy.
- Promotes clear communication and ensures patient needs and requests are handled efficiently by communicating to the patients care team through our EHR and scheduling of patient initial and follow up appointments as needed
- Performs administrative tasks like (but not limited to) Portal Uploads, Release of records, Referral Notes for any open active orders (3-6months), confirming appointments, etc.
- Helps manage high-risk patient care, including management of patients with multiple co-morbidities and/or high risk for readmission to a hospital setting, including data entry/management, outreach attempts, and scheduling to improve patient outcomes.
- Works collaboratively with Value Based Care team for data collection, reporting, clinical audits and programmatic evaluation.
- Will perform high volume of daily patient outreach calls while still attending to incoming calls.
- Perform patient pre-registration including accessing and updating patient information as indicated
- Perform data entry
- Maintain schedule accuracy for maximum patient flow
- Follow established procedures for answering and screening incoming appointment-related telephone calls, scheduling interpreters, and directing calls to appropriate staff
- Constantly sustains and improves present expectations of internal and external patient clinical goals.
- Maintains good attendance, is punctual and works full scheduled shift
- Coordinates continuity of patient care with external healthcare organizations and facilities such as referrals to outside specialties; ongoing two-way communication between providers.
- Maintain effective communication with team, office staff and providers across all health centers as needed
- Facilitates patient care based upon standing orders and protocols.
- Ensure patient needs and requests are handled efficiently by performing telephonic patient scheduling of patient initial and follow up appointments.
- Identify preventable exams, gaps in care, and suspect conditions closure opportunities for payors and strategize submission in a timely manner.
- Consolidate submission outcomes in a clear and concise manner.
- Ensure all data is always ready and available as needed for further evaluation.
- Ensure payor audit needs and request are handled in an efficient and timely manner.
- Facilitates payor audit visit for in house medical record extraction and ensure compliance of visitors
Additional Duties and Responsibilities
- Other duties as request or assigned
All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team-based model to promote wellness and improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcare’s written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelante’s legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.