Care Coordinator Specialist Clinics

Why Join Us?

Be Valued for What You Bring to the Team – Competitive pay that rewards your hard work
Benefits You Can Count On – Medical, dental, vision, and life insurance coverage
Work Hard. Recharge Often. – Generous PTO and extended illness benefits
Invest in Your Future – 401(k) with company match
Grow With Us – Career development, learning opportunities, and advancement pathways
We Invest in Your Success – Employee rewards and recognition programs
Your Wins Deserve Recognition – Employee rewards and recognition programs
Your Team – A collaborative, purpose-driven culture making a difference every day

Job Summary

The Care Coordination Specialist Clinics is responsible for assisting in the coordination of patient care with referrals and/or authorizations for services. Works with providers and clinical staff to ensure all orders have been submitted and appropriate documentation is sent to the referral provider. Notifies patient of appointment time and location and/or contact information of the referral provider to ensure all services ordered are completed.

Qualifications

• Detail-oriented and organized despite frequent interruptions
• Able to work independently
• Able to communicate effectively in a professional and constructive manner with patients and their family members

Scope

Physician practice clinic

Care Coordination Specialist Responsibilities

• Coordinates all incoming and outgoing referrals ordered/received by the providers in the clinic within two (2) business days of the order being submitted.
• Ensures orders are completed in the electronic health record and linked to the referral requested.
• Validates continuity of care and network integrity based on service line availability for quality patient care.
• Sends all required and appropriate documentation to the referral provider for services requested and ensures patient records are updated appropriately.
• Schedules and notifies patient of referral appointment, provides appointment information (date, time, directions, etc.), and contact information of the referral provider.
• Provides and/or obtains required authorization for services as needed and works with patient insurance to validate coverage of services; continuously follows up with the insurance company until there is resolution of the prior authorization request — an approval, redirection, or denial. All activity including pre-cert number is recorded in the “Authorization Workflow” within Athena and/or practice management system.
• Schedules and notifies patient of referral appointment, provides appointment information (date, time, directions, etc.), and contact information of the referral provider.
• Coordinates with appropriate staff or obtains information relative to the patients out of pocket expense, including co-insurance and deductibles; also works with patient to establish a plan to pay in advance of scheduling procedures or follow up care as ordered in accordance with established policies and procedures. All activity is documented in Athena and/or the practice management system.
• Demonstrates excellent communication and problem-solving skills when assisting with questions or resolving problems with patients, patient families, and other clinic staff.
• Maintains confidentiality with patient’s financial, personal, and medical information according to HIPAA guidelines.
• Fulfills all regulatory requirements and complies with all policies and standards.