Care Coordination Specialist Clinics
: Job Details :

Job DescriptionThe 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 thereferral provider. Notifies patient of appointment time and location and/or contact information of the referral provider to ensure all services ordered are completed.Essential Duties and Responsibilities (Including, but not limited to):* 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 patients 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, Manger, Director.* Responsible for all other duties as assigned by clinic leadership.Qualifications: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.Required Education: Minimum High School Diploma or GED EquivalentPreferred Education: Associates Degree and/or Technical School for MedicalBilling/CodingRequired Experience: 1 year in a medical or health-related field of workPreferred Experience: 1-2 years in a medical or health-related field of work specializing inreferrals/authorizationsRequired License/Registration/Certification: N/APreferred License/Registration/Certification: N/AComputer Skills Preferred:Google Suite including Gmail, GDrive, GSheets, GCalendar, etc.Microsoft Office Suite including Word, Excel, Power Point, and VisioKronos, Athena, and the ability to learn multiple new systems being used in the organization to perform daily operational activities