Overview:
POSITION TITLE: Patient Retention & Utilization Specialist
DEPARTMENT: Quality Improvement
REPORTS TO: Quality Improvement (Q.I.) / Risk Management Coordinator
POSITION OVERVIEW:
The Patient Retention & Utilization Specialist is responsible to contact all applicable patients to attempt retention efforts and/or ensure increased utilization of all needed FHCCGLA services. The primary focus of this position will be maintaining patient retention and maximizing utilization of services. Shall outreach to active and non-active patients who have not received services within the recommended periodicity.
Responsibilities:
DUTIES/RESPONSIBILITIES:
Responsible for establishing and implementing strategies to improve utilization and retain patients through changes.
Collaborates with other departments to increase retention, utilization and access to care and services as needed.
Enhance communication with patients regarding FHCCGLA services to improve quality service, reduce no-show rates, retain patients and ensure utilization of all services such as:
■ Women’s Health
■ Behavioral Health
■ Dental
■ Optometry
■ Nutrition
■ Podiatry
Works in conjunction with quality improvement department with guidance from the C.M.O. to develop and implement strategies to better engage and retain patients.
Contacts new and non-active patients to connect them to pertinent care services.
Responds to patients’ inquiries and follows-up on patient issues and resolutions to ensure quality customer service.
Coordinates resources to improve patient ability to adhere to appointments, including assistance with transportation.
Maintains knowledge of eligibility, enrollment, and program specifications for CHDP, Medi-Cal, Medicare and other insurance programs.
Conducts GAP reports from, NextGen and COZEVA to track utilization of services and determine which patients are due for various preventive care health maintenance measures and follow-up.
Follows all FHCCGLA safety, regulations, practices and policies & procedures.
Works with the operations managers to manage patient scheduling and flow to address bottlenecks, scheduling issues, etc. – notifies supervisor of all concerns.
Ensures HIPAA compliance by maintaining strict confidentiality of all patient data and E.H.R./Practice Management System (PMS) according to regulations and FHCCGLA’s P&P’s.
Remains informed of specific programs/payors, insurances accepted, and services being offered at FHCCGLA.
Serves as a liaison between clients and medical staff.
Assists clients with completion of forms.
Educates clients regarding available benefits (health coverage programs) and will refer directly to FHCCGLA outreach & enrollment specialists for eligibility screening and/or application assistance.
Participates in key pertinent meetings, such as:
■ Quarterly Staff (Q.S.) Training
■ Q.I./Q.A.
■ Medical Advisory Committee (M.A.C.), as needed
■ Etc.
All other tasks as assigned.
Qualifications:
MINIMUM QUALIFICATIONS:
High school diploma, minimum (or GED equivalent).
FQHC experience, highly preferred.
Excellent analytical & reasoning skills.
Motivation to take initiative and multi-task to ensure all tasks performed are completed thoroughly, accurately and with minimal or no errors.
Excellent writing and verbal communication skills. Highly enthusiastic, approachable and confident communication style capable of motivating others.
Knowledge of administrative principles and procedures.
Computer knowledge preferred (e.g., NextGen (E.H.R. & PMS), Microsoft Word, Excel & PowerPoint).
Ability to adapt to changing schedules, deadlines and demands, and a heavy workload (e.g., late entry to stay late to contact patients unable to reach).
Must be able to communicate effectively, in both English & Spanish, verbally and written.
Exercises good judgment and professionalism when dealing with all FHCCGLA patients.
Ability to work with patients and staff from diverse socio-economic, ethnic and cultural backgrounds, preferred.
Strong interpersonal and problem-solving skills, to include persuasiveness, assertiveness and sensitivity when dealing with patients as well as agency staff.
Willingness to adapt to changes in clinic schedules, agency growth and expansion.
Ability to function self-sufficiently, requiring little supervision.
Commitment to the mission & vision of Family Health Care Centers of Greater Los Angeles, Inc.
Transportation required. Will need to travel to FHCCGLA clinic sites as necessary.
Evenings and weekends may be required, with advanced notice when feasible.
Current California Driver License.
ADDITIONAL ELIGIBILITY QUALIFICATIONS:
Ability to work well with others in a professional and team-oriented environment.
Well-developed interpersonal skills, friendly personality and able to motivate staff by promoting teamwork.
Willingness to travel.
Strong planning and organizational skills.
Problem analysis and critical thinking skills.
Excellent customer service skills.
Knowledge of the following (but not limited to), preferred:
■ My Health LA
■ PPO’s
■ HMO’s
■ Medicare
■ Family PACT
■ CHDP
■ Medi-Cal
■ Managed Care Plans