Under the general supervision of the Manager, Care Coordination, this position is responsible for coordinating the medical access services of Justice Health & Equity (JHE). This includes communication and coordination with clinical and administrative staff of federal prisons, communication of schedules at multiple locations, scheduling of medical services delivered at the prison, managing critical data and maintaining automated databases, producing reports and documentation and providing education and support regarding security issues to staff and clinicians. All work is performed under strict contractual requirements. This position is responsible for coordination of care directly within a Federal Bureau of Prison site as well as remotely.
This position performs complex and varied duties associated with the coordination of medical services for FBOP patients through the use of the JHE claims processing software as well as Teams, Word, Excel, Access, Adobe, EMRand Outlook applications. The Care Coordinator is the primary contact for the community-based provider network, interfacing between bureau providers requesting services and the provider network performing the services. This position makes complex decisions regarding protected healthcare information (PHI) based on the Federal regulations regarding the protection of health information under the Health Information Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. This position is the primary hub for all coordination of medical services, and interacts with clients, providers, and staff regarding establishing prison medical appointments.
Responsibilities
Coordinates the complex scheduling of medical services for the Federal Bureau of Prisons (FBOP). Maintains a process for scheduling network hospital appointments that is consistent with the contractual requirements and FBOP security protocols . Utilizes independent judgement to continually identify and resolve barriers to service
Works remotely from the Federal Medical Center at Devens at least two days a week coordinating and running all aspects of assigned onsite specialty clinics
Acts as the primary point of contact for the Justice Health & Equity (JHE) contracted specialty provider for the assigned clinics. Has direct involvement with patients around coordination of care during clinics.
Prepares medical records for onsite specialty clinics including but not limited to related imaging, test results, off site medical record reports and patient history for all scheduled patients
Utilizes Bureau of Prisons Electronic Medical Record (BEMR) to review consultation requests and create inmate patient schedule. Reviews schedule with Sr. Care Coordinator and FBOP clinical leadership team prior to clinic to account for any urgent appointment requests based on patient needs.
Audits encounter forms as well as provider BEMR documentation for accuracy and reviews any potential issues and discrepancies with provider prior to clinic end. Provides continuous education to providers to ensure patient encounters are completed thoroughly and accurately for claims submission
Audits the daily time sheets of contracted providers documenting hours worked
Maintains proper boundaries when interacting with patients; seeks direction or clarification from supervisor and/or BOP staff when necessary
Reviews daily written consultation requests/ medical referrals from the FBOP primary care team. Reviews consultation requests for accuracy and completion, clarifies requests with prison staff, and adds referrals as the prior authorization to claims processing software.
Identifies problematic or incomplete consultation requests/medical referrals. Determines gaps in service delivery hospital network. Research potential out of network alternatives and works with Manager, Care Coordination to fulfill service requests
Serves as the primary liaison between FBOP providers and staff and community-based physicians and their staff to schedule services, communicate information and identify and resolve issues regarding medical appointments and procedures.
Collaborates with FBOP healthcare team communicating status of referrals and changes to ensure continuity of care
Provides the linkage between FBOP referring providers and community providers to promote the timeliness and efficiency of services
Develops and maintains a system to request and retrieve medical record information for all scheduled appointments and procedures, ER trips, and inpatient stays for FBOP patients across all network hospitals. Ensures timely delivery of medical record reports, test results, imaging and other critical communications to the FBOP primary care team.
Reviews all medical referrals to ensure that an appropriate provider is chosen based on specialty of the service, the geographical location, the provider's availability and the client's preference while being fiscally responsible and leveraging our primary network hospitals when appropriate
Maintains the schedule for medical services provided at the prison. Anticipates variances in enough time to allow for correction. Collects time sheets documenting hours working on a weekly basis
Maintains referrals/prior authorizations, patient appointments, ER trips and inpatient stays in the JHE claims management software. Produces data and reports on utilization, types of services and access to services
Independently develops and continuously delivers education regarding FBOP safety and security protocols regarding inmates as patients to the community hospital network providers and their staff.
Makes complex decisions regarding privacy matters associated with the client's case, including determination of who JHE may exchange information with, what information may be shared and what is required, by HIPAA, to allow conversations to take place
Corresponds and communicates daily with community providers and FBOP handling sensitive and confidential records/information for clients. Communicates confidential information via phones & secure email
Ensures accurate appointment and scheduling information is entered into the JHE claims management system in a timely manner. Produces daily and weekly audits of prior authorizations and scheduling data for accuracy
Provides critical, highly sensitive scheduling and utilization reports to the FBOP client for continuity of care planning and security staffing per contract requirements
Addresses clients, providers, and agencies in an expert manner with excellent written and verbal communication & organizational skills. Resolves all issues and ensures that electronic data transmission is performed in a secure manner, according to FBOP & ForHealth Consulting data security policies and procedures
Complies with established policies, health & safety regulations and requirements, procedures and department objectives
Performs scanning functions, faxing, scanning of daily provider schedules, letter to providers, dictations to sign and other documents on a daily basis
Monitors & evaluates all care coordination procedures and identifies areas for improvement. Initiates & implements new procedures in collaboration with Care Coordination team, Claims team and FBOP Health Information Management team as needed
Perform other duties as assigned
Qualifications
High School Diploma
3 to 5 years of relevant complex office or direct healthcare experience
Demonstrated knowledge of medical terminology
Knowledge of HIPAA laws and regulations especially as it refers to the confidentiality of PHI
Knowledge of Microsoft Office products, Word, Excel, PowerPoint, and Outlook
Ability to handle stressful and difficult situations in a calm and professional manner
Must possess demonstrated verbal and written communication skills necessary to work effectively with diverse population, both on the telephone and in person
Attention to detail, ability to prioritize and function independently
Position is contingent upon passing a background check from the Federal Bureau of Prisons and a willingness to work within a Medical Center operated by the Federal Bureau of Prisons
Additional Information
Preferred Education and Experience
Associates degree or some college in business or related field, including healthcare
Experience in a high functioning, multi-faceted, medical setting
Ability to independently organize and prioritize work responsibilities and the demonstrated ability to apply critical thinking skills to solve problems
Familiarity with medical terminology and CPT codes strongly preferred
Excellent communication and interpersonal skills
Knowledge of ForHealth data security procedures, standards and requirements regarding the confidentiality of protected health information
