Health Information Management (HIM) Coordinator

Description

The HIM Coordinator is responsible for the organization, maintenance, retrieval, and protection of participant health records. This role also encompasses the critical function of managing participant referrals and authorizations. The coordinator ensures the accuracy, confidentiality, and integrity of all medical records, and the timely processing of referrals, all in compliance with Medicare/Medicaid regulations, HIPAA, and PACE-specific requirements. The HIM Coordinator provides essential support to the Interdisciplinary Team (IDT) to ensure seamless care coordination and is accountable for overall participant health outcomes.

Requirements

Health Information Management & Compliance

• Record Management: Manage all aspects of participant health records, including assembly, analysis, and indexing of electronic and paper records. Ensure all required documentation is complete, timely, and properly filed.
• Compliance & Privacy: Maintain strict confidentiality of all participant information in accordance with HIPAA, state laws, and High Desert PACE policies. Conduct regular audits to ensure compliance with documentation standards and regulatory requirements (e.g., CMS, DHCS).
• Coding & Billing Support: Assist with the accurate assignment of codes (ICD-10, CPT, etc.) for diagnoses and procedures to support proper billing and encounter data submission.
• Data Integrity & Documentation: Maintain the integrity of the Electronic Health Record (EHR) system. Document all actions taken (e.g., referral status, communication) in the participant medical record in accordance with current Clinic, DHCS, and CMS regulations/guidelines.
• Release of Information (ROI): Process all requests for protected health information in a timely and compliant manner.
• Record Retrieval: Request and facilitate the timely retrieval of consultation reports, CD images, and other necessary medical records from specialty offices and clinics for review by the PACE Medical Director.

Referral and Authorization Management

• Referral Processing: Serve as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling. Prepare, process, and complete all referrals accurately and in a timely manner, including urgent and stat referrals.
• Authorization Tracking & Follow-up: Track all referrals in designated logs and/or the EMR. Follow up on submitted authorization requests and maintain consistent status updates. Monitor and report on statuses of authorization requests, escalating issues as necessary until fully resolved and the referral loop is closed.
• Re-authorization Management: Manage the needs for re-authorization across all payors by working with clinical teams to ensure timely re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care. Submit retro-authorizations as required.
• Appointment & Transportation Coordination: Communicate referral details and appointment information/instructions to participants and their families. Arrange transportation for participants to medical appointments at High Desert PACE and other organizations, including escort coordination. Reschedule missed appointments and notify the provider according to no-show policies.
• Surgery Scheduling: Complete surgery scheduling with proper CPT codes and all needed follow-ups, including pre- and post-order management, labs, EKG, images, etc.
• Coordination & Liaison: Act as a liaison between the participant, clinic/providers, specialty care providers, hospitals, and other community resources. Screen and answer all referral-related communications by telephone, text message, patient portal, and/or mail.
• Follow-up Review: Review consultation reports for needed follow-up requests and work with providers to ensure timely processing of all follow-ups.
• Eligibility & Payor: Verify Medi-Cal Eligibility, as needed, and distinguish between primary care and internal specialty visits for authorization purposes.
• Participant Advocacy: Advocate and discuss with participants all aspects of the referral process as needed or requested by the treating provider.
• Administrative Support: Make assigned reminder calls and perform other duties as assigned.

Education & Experience

• Required: Associate’s degree in health information management, Health Informatics, or a related field. Comparable experience will be considered in lieu of degree. 
• Preferred: Two (2) years of experience in Health Information Management, preferably within a managed care, long-term care, or PACE environment.
• Experience with Medicare and Medicaid documentation, coding, and prior authorization rules is highly desirable.

Certifications

• Preferred: Registered Health Information Technician (RHIT) or eligibility for certification.
• Preferred: Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS).

Skills & Abilities

• Exceptional knowledge of HIPAA and other federal/state regulations governing health information and managed care authorizations.
• Proficiency with Electronic Health Records (EHR) systems and referral tracking platforms.
• Strong understanding of medical terminology, anatomy, physiology, and disease processes.
• Excellent organizational skills and meticulous attention to detail.
• Ability to work effectively in a collaborative, fast-paced interdisciplinary team environment.
• Excellent written and verbal communication skills.

Working Conditions

The working conditions and physical demands 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.

• Primarily work indoors.
• Usually have their own office or a shared office space
• Are exposed daily to participant’s who have diseases or infections.
• Wear protective clothing such as gown, masks and gloves, as needed
• Work very close to others, especially when examining participants
• While performing the duties of this job, the employee is frequently required to walk, sit, and/or stand
• The employee must occasionally lift and/or move up to 25 pounds.