Patient Care Coordination Specialist

Location 400 S Broadway St,Burlington, IA, 52601,United States Job Category Administrative / Clinical Employee Type FT Non-Exempt Required Degree High school Manage Others No Contact information Name LISA BABCOOK Phone View phone number on click.appcast.io Description POSITION SUMMARY The Patient Care Coordination Specialist is responsible for coordinating patient care activities that support timely access to healthcare services. Responsibilities include referral and diagnostic test tracking to ensure a closed-loop referral process, patient communication and care coordination, assistance with ca se management activities, and management of prior authorization requirements for medications, diagnostic studies, specialty services, procedures, and other assigned services. This role serves as a liaison between patients, providers, payers, and external organizations to remove barriers to care, promote patient safety, and ensure timely completion of ordered services ESSENTIAL FUNCTIONS / DUTIES Ensure timely follow-up and completion for all referral orders to specialty providers (external and in-house), specialty services and diagnostic studies. Ensure that the Electronic Health Record (EHR) tracking reports are used to track and follow up on outstanding referral/diagnostic orders which will promote care team awareness and ensure patient safety Follow CHC/SEIA policies, training guides and other training documents related to referrals tracking. During the tracking process, review details and expectations about referral/diagnostic order with patient and recognize the need to provide information about the referral/diagnostic order in the patient’s preferred language/mode of communication. Will request and use interpreters as needed and will perform in a culturally competent manner. During the tracking process, attempt to identify potential patient barriers to care and offer assistance by connecting to area resources , the CHC/SEIA Community Health Worker (CHW) or external health navigator. Ensure patients E H R is up to date with information from referral and recommended follow-up and/or needed tracking from the referral report/provider recommendation is completed/put into place prior to completing “closing the loop” on a referral. Will accurately document all follow-up actions, phone calls, conversations, etc. related to referral tracking in the appropriate EHR templates. Assist clinical support /nursing staff with coordination of patient care including but not limited to: contacting patients to schedule for annual risk assessment/exams (e.g. Medicare/Medicaid) Evaluate authorization requests within the Electronic Medical Record (EHR) and determine authorization requirements through chart review, payer resources, and third-party systems. Maintain knowledge of Medicare, Medicaid, and commercial payer authorization requirements, coverage policies, eligibility criteria, preferred provider networks, and accepted insurance plans. Obtain prior authorizations for diagnostic studies, specialty services, procedures, and other assigned services while minimizing delays in patient care. Review authorization denials, assist with appeal processes as appropriate, and advocate on behalf of patients through follow-up with providers, patients, and third-party payers. Communicate with providers regarding diagnosis codes, documentation requirements, medical necessity information, and other information required to support authorization requests. Coordinate peer-to-peer reviews between providers and insurance carriers when required and assist with scheduling related appointments, tests, procedures, and specialty consultations. Maintain accurate and timely documentation of all authorization-related activities, communications, decisions, and follow-up actions within the EHR and other required systems. Educate patients, providers, and staff regarding referral and authorization requirements, payer coverage policies, eligibility guidelines, documentation requirements, and insurance-related updates. Prioritize referral and authorization work queues to ensure timely processing and completion of patient care activities. Demonstrate proficiency in medical terminology, insurance authorization processes, medical office procedures, and electronic health record workflows. Respond to patient, provider, payer, and internal staff inquiries via phone, email, and other communication methods within established departmental service standards. Identify and connect patients with internal and external resources that may help address financial, insurance, transportation, language, or other barriers to completing recommended care. Participate in care coordination and case management activities for assigned patient populations. Perform other job-related duties as assigned. EDUCATION Graduate from an approved Medical Assistant training program, or Graduate from an approved Licensed Practical Nurse training program, is preferred EXPERIENCE Minimum of two (2) years medical experience or similar experience LICENSURE Certified by the State of Iowa as a Certified Medical Assistant or Licensed Practical Nurse, preferred. BLS Certified; Mandatory Reporter for Child and Dependent Adult Abuse Requirements Remaining in a stationary position, often sitting for prolonged periods. Communicating with others to exchange information. Repeating motions that may include the wrists, hands and/or fingers. Assessing the accuracy, neatness and thoroughness of the work assigned. #J-18808-Ljbffr Community Health Centers of Southeastern Iowa, Inc.