Value Based Care Coordinator- Medical Assistant

CompanyAt Catalyst Physician Group, primary care is redefined! As a physician-owned and physician-led organization, we are dedicated to transforming healthcare by putting patients at the center of everything we do. Our team of over 100 physicians and 500 employees operates across 21 locations in North Texas, providing personalized, accessible care that helps communities thrive.Job SummaryThe Value-Based Care Coordinator supports primary care clinics by executing standardized workflows that drive value-based care performance across Commercial and Medicare populations. This role focuses on patient outreach, scheduling, care gap closure support, and provider workflow preparation to ensure patients are connected to care and providers are equipped to address quality and risk opportunities during visits.Roles And ResponsibiltiesPatient Outreach and SchedulingConduct targeted outreach to patients to support completion of recommended care including:Annual Wellness VisitsPreventive screenings (e.g., mammogram, colorectal cancer screening)Chronic disease follow up (A1C, blood pressure checks)Prioritize outreach to high-risk, high-opportunity, and care gap populationsSchedule appointments and coordinate folow-up to support timely completion of careDocument outreach and scheduling activities in the EMRCare Gap Closure SupportIdentify patients with open care gaps using available reports and toolsSupport closure of care gaps by scheduling required services and coordinating with clinic teams and referral partnersTrack completion of recommended services and update systems accordinglyProvider Workflow Preparation (Enablement)Prepare and ensure availability of tools that support provider performance at the point of care including:BOI/diagnosis capture formsEncounter plans and clinical pathway toolsSupport pre-visit planning by identifying outstanding care gaps and relevant patient needsEnsure information is accurate and available to reduce missed opportunities during visitsQuality, Documentation, and ComplianceExecute workflows that support:Quality measure reporting and submissions (HEDIS / Star)Attestations / MIPs and required documentation processesSupport provider documentation readiness through standardized workflows (e.g., BOI preparation)Reconcile labs/imaging, consults, and externa records to ensure information is available for complete and accurate documentationCare CoordinationCoordinate follow-up care, referrals, and diagnostic testing as neededCommunicate with patients, providers, and clinic staff to support continuity of careAssist with clinical program enrollment and follow-up activitiesOperational SupportMaintain assigned work queues, inboxes, and reportsFollow standardized workflows and escalate issues or barriers as appropriateProvide cross-coverage for team members as neededParticipate in team meetings and ongoing trainingPerformance ExpectationsOutreach productivity and effectiveness (contact and scheduling rates)Appointment completion for targeted populationsSupport of care gap closure through scheduling and follow-upAccuracy and timeliness of documentation and workflow executionAdherence to standardized processsesMiniumum Qualifications And RequirmentsLVN, Certified Medical Assistant, or equivalent clinical experience required2-4 years of experience in a clinical or physician office settingExperience with EMR systems (Athena preferred)Strong organizational and communication skillsAbility to manage multiple priorities in a fast-aced environmentPreferred ExperienceExperience in value-based care, quality, HEDIS, or care coordination workflowsExperience with patient outreach and population health initiativesFamiliarity with Medicare and Commercial value-based programsCompetitive Benefit PackageCompensation commensurate with experienceMedical, Dental, Vision Insurance401K with Employer MatchHealth Savings Account OptionsPaid Holidays and PTOReferral ProgramsShort/Long Term Disability InsuranceAt Catalyst, we believe in the power of relationships. Our patient-centric approach ensures that every individual receives comprehensive, connected care at all stages of life. From on-site lab services and telehealth to pediatrics and weight loss programs, we offer a wide range of services to meet diverse healthcare needs.Join us in our mission to advance health through integrity, honesty, and exceptional patient care. Be a part of a dynamic team that is making a real difference in patient lives across all demographics and health spectrums. Together, we are Catalyst Physician Group - where your career can flourish as you help communities thrive.