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 for this job include, but are not limited to, detail-oriented and organized despite frequent interruptions, ability to work independently, and the ability to communicate effectively in a professional and constructive manner with patients and their family members. (Note: Individual market workflows may vary based on clinic infrastructure.) Scope: Physician practice clinic Care Coordination Specialist responsibilities include all inpatient/outpatient clinic referrals and functions under the administrative supervision of the Revenue Cycle Supervisor, Manager, Director OR Clinic Supervisor, Manager Director.
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. 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. Ensures patient has the information necessary to make critical care decisions and may provide information to patient caretakers in accordance with HIPAA. 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. Follows proper chain of command and reports issues, problems, opportunities, and important information to Revenue Cycle Supervisor, Manager, Director and/or Clinic Supervisor, Manager, Director. Performs other duties as assigned.
Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications Associate Degree In medical related field preferred or Technical School In medical related field preferred 0-1 years One (1) year of experience in a medical or health-related field of work required and 0-1 years One (1) year of experience in a medical or health-related field of work specializing in referrals/authorizations preferred Knowledge, Skills and Abilities Google Suite including Gmail, GDrive, GSheets, GCalendar, etc.
Microsoft Office Suite including Word, Excel, Power Point, and Visio Kronos, Athena, and the ability to learn multiple new systems being used in the organization to perform daily operational activities