Medical Assistant - Care Gap Coordinator

The Wright Center Medical Group•Jermyn, PA

1d•Onsite

About The Position

The Medical Assistant’s primary responsibility is to assist in the delivery of health care management for the health center. This includes actively participating in and supporting primary clinical teams, with a strong focus on improving patient outcomes through proactive care coordination. The Medical Assistant plays a key role in identifying, addressing, and closing care gaps, including preventive screenings, point of care testing, and vaccinations, and ensuring accurate documentation and data capture to support quality reporting and population health initiatives. Additionally, the Medical Assistant supports Chronic Care Management (CCM) initiatives by assisting in the coordination of care for patients with chronic conditions, contributing to monthly care management activities, and collaborating closely with the Licensed Practical Nurse (LPN) and care team to ensure appropriate tracking and documentation of CCM services. The Medical Assistant behaves in a professional manner and consistently demonstrates and promotes the values of the organization.

Requirements

Medical Assistant certification or equivalent experience
Experience in a clinical setting
Familiarity with EMR systems
Knowledge of HIPAA policies
Ability to perform vital signs, EKGs, blood draws, and administer injections
Understanding of laboratory testing procedures
Excellent communication and interpersonal skills
Ability to work independently and as part of a team
Strong organizational and time management skills
Ability to multitask and prioritize effectively
Proficiency in medication reconciliation and family/social history documentation
Experience with quality reporting systems (e.g., HEDIS, UDS)
Familiarity with Chronic Care Management (CCM) initiatives
Ability to navigate supplemental ACO tools (e.g., Azara)
Understanding of patient portal registration and troubleshooting
Experience with patient registration, scheduling, and check-out procedures
Knowledge of health center resources and programs (e.g., Sliding fee discount, GFE, Outreach & Enrollment, Language services)
Ability to comply with PPE requirements and safety regulations

Nice To Haves

Experience as a Care Gap Coordinator
Experience with Wright Center medical policies and procedures
Experience with spirometry, audiometry, BP checks, allergy shots, UA/UC, urine drug screens
Bilingual abilities

Responsibilities

Become familiar with provider tendencies and provider’s established patient’s conditions
Distribute Patient Agenda
Complete medication reconciliation every visit, including over the counter meds
Complete Family and Social histories
Move patients from waiting room to treatment room
Perform vital signs, acquiring any recent test results, and ascertain reason for visit
Prepare patient and gathering all necessary information
Identify, track, and take ownership of closing care gaps, including preventive screenings and vaccinations, in alignment with clinical guidelines and organizational quality measures
Navigate Azara and other supplemental ACO tools appropriately
Identify and outreach patients for needed tests/screenings/appointments
Ensure all care gap actions are accurately documented in the EMR and that appropriate data is captured and submitted to support closure of gaps in quality reporting systems (e.g., HEDIS, UDS, and other value-based care metrics)
Coordinate with providers and care team members to complete required screenings, orders, and follow-ups needed to successfully close care gaps
Educate patients on preventive care needs and assist with scheduling, completion, and follow-up to ensure gaps are fully closed
Report any changes observed in condition or behavior of patient
Prepare room for the practitioner
Perform simple procedures according to Wright Center medical policy/procedures
Give inoculations; draw blood, EKGs and /or any other provider requests
Participate in quality assurance activities to monitor and improve patient care quality
Complete any forms or growth charts as appropriate before practitioner sees patient
Assist with examination, diagnostic and treatment procedures
Enter requisitions in EMR
Prepare and send out specimens
Stock treatment rooms and all clinical areas as needed daily; alerting Health Center Manager of any supplies that need to be ordered
Keep all exam rooms, hall, and lab area neat and clean
Follow all standing orders as needed
Facilitate spirometry, audiometry, BP checks, allergy shots, UA/UC, urine drug screens and other procedures that are necessary
Attend all staff meetings
Provide back-up to other co-workers as necessary
Understand and adhere to professional office standards
Be familiar with and implementing all office policies and procedures
Participate when appropriate in unit-based quality initiatives
Perform Laboratory testing
Maintain a safe, secure, and healthy work environment by following standards and procedures and in compliance with legal regulations
Comply with established personal protective equipment requirements necessary for protection against exposure to blood and other potentially infectious body fluids, chemical disinfectants, and other hazardous substances
Prepare and administer medications and injections per provider
Ensure patients understand health center resources and available programs, such as Sliding fee discount program, Good Faith Estimate (GFE), Outreach & Enrollment programs, Language services
Ensure compliance in the following areas: Availability and location of SDS and 990 binders
Understanding role and responsibilities in an emergency to help coworkers and patients to safety
Make timely call backs and inform patients of their test results
Work in close support of health center medical director, physicians, nurses, care manager and other providers
Become familiar with HIPAA policies regarding privacy and security of patient health information that will always be exercised by this position
Be responsible for registering and activating patients on their individual portal accounts
Assist and guide patients to troubleshoot issues related to portal usage
Schedule patient appointments and follow-up visits
Answer and return phone calls
Intake and check out of patients
Ensure copays are collected at time of visit
Create triages within the EMR system
Participation in rotation of extended access hours including late nights, weekends and holidays
Cross coverage of other locations and service lines for continued support and access for patients