Patient Care Coordinator

Sedgwick Claims Management Services Ltd; Town of Florida (NY); Hybrid; USD 1,875,000 - 2,671,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k and matching

PTO

Disability and life insurance

Flexible spending or health savings

Job summary

Sedgwick Claims Management Services Ltd is seeking a detail-oriented professional to provide world-class customer service and manage referrals for medical goods and services. The role emphasizes accurate data, timely updates, and clear communication with clients, vendors, and care managers.

You will confirm demographic information, coordinate with partners, procure vendors, and quote referrals while ensuring medical necessity and proper billing.

Qualifications

• Education: High school diploma or GED required.
• Experience: Two years in healthcare network and patient care scheduling or equivalent.

Responsibilities

• Contact patients to confirm demographic details and updates on referrals.
• Coordinate with vendor partners, claims adjusters, and nurse case managers.
• Procure vendor partners for each referral as needed.
• Handle phone calls for existing or new referrals and related teammates’ referrals.
• Provide quotes to clients and obtain written approval; ensure medical necessity and approval.
• Verify billing information for referrals and move them to billing each day.
• Process referrals in compliance with state regulations and workers' compensation guidelines.

Skills

Strong customer service

Critical thinking

Self-Starter

Written & verbal communication

PC literate

Analytical skills

Organizational skills

Interpersonal skills

Report writing

Teamwork

Performance competencies

Education

High school diploma or GED

Tools

Microsoft Office

Job description

CULTURE

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Patient Care Coordinator

PRIMARY PURPOSE

To provide world class customer service and service delivery to our clients and patients through processing referrals in the delivery of medical goods and services.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Reaches out to patients in relation to new or already processing referrals confirming patient demographic information, providing updates on the referral, and/or confirming delivery of said goods or service.
• Communicates with vendor partners, claims adjusters and nurse case managers providing updates on new referrals as well as referrals already in process.
• Procures vendor partners for each referral as it relates to the goods or services requested.
• Responsible for making or taking phone calls on existing referrals, new referrals, or other team members referrals.
• Provides quotes back to clients for approval or follow up on quotes already sent to obtain written approval for requested referrals ensuring that each referral is deemed medically necessary and approved by the claim's adjuster.
• Confirms all required and relevant billing information exists in each referral as it relates to the workflow and billing processes in place and moves those referrals to be billed each day.
• Processes referrals per state regulations and workers compensation guidelines.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

QUALIFICATIONS

Education & Licensing: High school diploma or GED required.

Experience: Two (2) years of industry experience in healthcare network and patient care scheduling or equivalent combination of education and experience required.

SKILLS & KNOWLEDGE

• Strong customer service skills
• Strong critical thinking skills
• Self-Starter
• Excellent oral and written communication skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Ability to create and complete comprehensive, accurate and constructive written reports
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

• When applicable and appropriate, consideration will be given to reasonable accommodations.
• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
• Physical: Computer keyboarding, travel as required.
• Auditory/Visual: Hearing, vision and talking.

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

For the jurisdiction noted in this job posting only, the range of starting pay for this role is $16.50.

BENEFITS

• medical
• dental
• vision
• 401k and matching
• PTO
• disability and life insurance
• employee assistance
• flexible spending or health savings account
• other additional voluntary benefits

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

For more, see sedgwick.com