Patient Care Coordinator - 20 hours

Alpine Physician Partners•Denver, CO
•$17 - $24•Hybrid

About The Position

The Patient Care Coordinator supports care coordination and healthcare service management for Medicare patients in a primary care practice. Working closely with healthcare providers, the coordinator helps ensure smooth care transitions and follow-up engagement for high-risk and vulnerable patients. The role involves patient-facing communication, support, and assistance throughout the healthcare journey, with the goal of improving patient satisfaction and care quality. This is a hybrid position, with approximately 80% remote work and periodic work hours in supported clinics.

Requirements

  • Two years of experience as a Medical Assistant.
  • Excellent knowledge of healthcare administration and patient care processes.
  • Strong understanding of clinical practices and care coordination.
  • Knowledge of medical terminology.
  • Experience with electronic medical records management.

Nice To Haves

  • CCMA certification; experience in a primary care setting or care management is a plus.
  • Bilingual in English and Spanish.
  • Experience with value-based care and Medicare Advantage.
  • Experience with care navigation or care coordination, including transitions-of-care support.
  • Knowledge of billing and insurance claims.
  • Certified Patient Care Coordinator (CPCC).
  • Experience in a primary care setting or care management.

Responsibilities

  • Coordinate care management activities with clinical teams, including pre-visit planning and retrieval of post-discharge summaries.
  • Facilitate information flow between healthcare entities, care teams, and systems.
  • Engage patients in health improvement activities and educate them on self-management to help avoid unnecessary emergency department visits and hospitalizations.
  • Support team huddles reviewing hospital census and population health data, closing care gaps, identifying high-risk patients who need visits, and reviewing utilization trends.
  • Manage a panel of high-risk patients by anticipating needs, addressing barriers to care, and coordinating access with their attributed primary care team.
  • Collaborate with patients, physicians, and care team members to assess progress toward health goals and document self-management measures and progress.
  • Maintain confidentiality and comply with HIPAA regulations; treat individuals with dignity and respect; and participate in professional development activities.
  • Monitor platforms for patient utilization events, including hospital admissions and emergency department visits, and document occurrences.
  • Perform and document transitional care activities, including 48-hour post-hospital follow-ups, medication reviews, obtaining hospital records, and scheduling transitional care management visits.
  • Work with healthcare providers and staff to identify patients for care transition services.
  • Support regular engagement and scheduling for high-risk, complex patients.
  • Work with Medical Receptionists, Medical Assistants, and clinicians to identify care gaps and risks that may lead to avoidable hospitalizations during patient visits.
  • Coordinate with the PHP Care Management Team to escalate issues involving C-SNP members in the office panel.
  • Ensure patients’ health plans are appropriately flagged in the EMR, including new C-SNP members.
  • Provide clinical follow-up and guidance to patients as needed to support effective care transitions.
  • Support the use of coding tools during clinic visits to capture chronic conditions.
  • Maintain accurate and timely documentation of care coordination activities.

Benefits

  • Medical, dental, and vision insurance.
  • 401(k).
  • Paid time off (PTO).
  • Employee Assistance Program (EAP).
  • Eligible for a quarterly performance bonus based on individual and/or company performance.
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