Care Specialist

Summary

The Care Specialist provides support to patient care by coordinating referrals, performing prior authorizations, processing medical records and helping new patients navigate the Goshen Physician Network. Under the direction of designated coordinator and manager, supports providers with coordination and processing of referrals, pre-certifications, and prior authorizations, including communication of insurance requirements to patients, colleagues, and providers. Maintains current knowledge of and communicates insurance requirements to practice staff.

Responsible for the handling of insurance verifications, a liaison with other offices, individuals, and external institutions and agencies. Serves as a patient navigator in a customer service oriented manner to support medical offices. Establishes and maintains good working relationships with patients and their families, physicians, and external customers. Accountable for comprehensive patient care by assuring a timely, efficient referral and prior authorization process for continued patient care.

Ongoing responsibility for assessing the current process, identifying opportunities for improvement and implementing changes as necessary.

• Minimum Education: High School graduate with a minimum of 2 years’ experience in a medical practice.
• Minimum Experience: General Knowledge of computer software and practice management databases is essential.
• Preferred Experience: Two to four years’ experience in a physician office environment. Proficiency in medical terminology preferred.