Care Coordination Specialist

The Care Coordination Specialist plays a vital role in supporting patients throughout the care management process. This includes identifying and enrolling patients, maintaining ongoing engagement, and ensuring consistent follow-up. The specialist works closely with healthcare providers to coordinate care, maintain accurate documentation, support billing readiness, and monitor care activities in alignment with program requirements.

Key Responsibilities

Patient Identification & Enrollment: Identify eligible patients, clearly explain care management services, and complete all necessary enrollment and consent documentation.

Eligibility Verification: Confirm insurance coverage, program eligibility, and any required authorizations prior to initiating services.

Patient Assessment: Collect comprehensive patient information, identify care needs and potential barriers, and escalate clinical concerns to the appropriate healthcare professionals.

Care Plan Development: Assist the clinical team in creating and updating individualized care plans that outline patient goals, follow-up activities, and necessary services.

Provider Coordination: Facilitate communication with physicians, specialists, and other healthcare providers to manage referrals, schedule appointments, and ensure continuity of care.

Ongoing Patient Engagement: Conduct regular outreach to encourage patient participation in care plans, and communicate approved health information and reminders.

Care Coordination: Monitor pending services, resolve scheduling and access challenges, and follow up on any outstanding patient needs.

Billing Readiness: Ensure all required consents, service records, time logs (where applicable), and supporting documentation are complete and accurate before billing review.

Documentation & Reporting: Maintain timely and precise records within electronic health record (EHR) systems and prepare reports related to enrollment, engagement, care activities, and outstanding tasks.

Compliance & Performance Monitoring: Adhere to HIPAA, CMS, and organizational policies while monitoring documentation quality, completion of follow-ups, and achievement of program performance targets.

Required Qualifications

- Knowledge of healthcare processes, medical terminology, and care management programs.
- Strong verbal and written communication skills with an empathetic approach to patient engagement.
- Ability to support care planning and maintain clear, accurate documentation.
- Proficiency in EHR systems, reporting tools, and standard office applications.
- Excellent organizational and time management skills to handle multiple patients and competing priorities.
- Effective problem-solving, follow-up, and coordination abilities.
- Awareness of HIPAA privacy regulations and CMS program guidelines.
- A results-driven mindset focused on service quality, timely coordination, and measurable outcomes.

Preferred Qualifications and Experience

- Relevant qualifications in healthcare administration, nursing, allied health, or related fields are preferred.
- Prior experience in care coordination, patient support, or healthcare operations is advantageous.
- Experience working with US healthcare providers or care management programs is considered a plus.

This role offers an opportunity to make a meaningful impact on patient care by ensuring seamless coordination and support throughout the care management journey.