Patient Care Coordination Specialist

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 case 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 patients 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 EHR 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, patien...