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Job Summary
This is an administrative position providing front line customer service to our clientele. The right individual will be friendly, efficient, multi-task-oriented and detail driven. This position requires skill in planning, organizing, and coordinating the completion of independent medical review, as well as the coordination of day-to-day office activities. This position is responsible for working effectively and efficiently to work directly with physician reviewers, supporting them in their daily administrative needs. This is a highly team-oriented position. The Case Fulfillment Coordinator position requires the ability to utilize a high level of critical thinking, work well under pressure and be deadline driven.
Essential Job Functions
• General responsibility for all administrative components of fulfillment workflow process for Utilization Review referrals
• Routes and coordinates all referrals for prior authorization, concurrent review, and retrospective review within the Utilization Review industry
• Uses discretion and independent judgment in handling patient or physician received documents and routes to appropriate administrative/clinical staff
• Works directly with physician reviewers maintaining communication regarding daily administrative review tasks
• Guide physicians to complete time-sensitive deadlines
• Ensures compliance processes and procedures are adhered to for all state, federal and referral/intake regulatory requirement for Utilization Review
• Responsible for administrative Quality Assurance components (i.e., templates, completed fields, spelling, grammar, etc.) following completion of physician review
• Comply with template standards for each client.
• Communicates with Director of Operations any referrals falling outside of standardized process
• Ensures seamless transition of all completed reviews to end-facing clients in a time sensitive manner
• Primary contact for receiving phone calls, managing incoming calls and communications with physician panel
• Responsible for ensuring proper jurisdictional case requirements, specialty requirements and conflicts of interest are utilized
• Uses discretion and independent judgment in prioritizing the workflow of all referrals
• Uses discretion and independent judgment in organizing and assigning time sensitive due dates to all physician panels
• Responsible for daily case load of a minimum of 75 cases daily
• Ability to work via web-based portal applications
• Maintain and organize all documentation logs regarding assigned physician reviewers
• Answer, screen and forward incoming phone calls regarding Case Fulfillment, while providing basic information when needed
• Ability to be resourceful and proactive in dealing with issues that may arise by working with team and Director of Operations
• Maintain security by following procedures and controlling access (HIPAA)
• Support others in a team environment
• The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this position. The incumbents may be requested to perform job-related tasks other than those stated in this description
Competencies
• Ability to use Microsoft products; Word, Excel, PowerPoint, Outlook
• Basic office equipment experience preferred (copier, fax, shipping and receiving tools)
• Written and verbal communication skills with a demonstrated ability to deliver excellent customer service
• Communicate professionally with physicians and clients
• Ability to multi-task and quickly adapt in a fast-paced environment
• Ability to handle difficult/irate callers in a friendly and professional manner
• Maintain a positive attitude and provide outstanding customer service while assisting physicians and their offices telephonically
• Strong organizational skills
• Attention to detail
• General Typing Skills at 65wpm
• Data Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kph
• Proficiency in English
• Exemplary planning and time management skills
• Ability to work in high pressure, deadline driven environment
• Ability to multitask and prioritize daily workload
• High level verbal and written communications skills
• Discretion and confidentiality
• Demonstrated ability to problem solve complex, multifaceted, situations
• Ability to engage easily in abstract thought
• Strong organizational and task prioritization skills
Education and Experience Requirements
- High school diploma or equivalent
- 1-3 years directly related experience in an office based professional setting
- General Typing Skills at 65wpm
- Data Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kph
Preferred Requirements
- Medical and/or Insurance experience
- Data Entry experience
License and Certification: None
Driving Essential: No
Position Demands
This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information.
Equal Employment Opportunity (Our EEO Statement)
The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and Human Resources Department. Discrimination and harassment will not be tolerated.
We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All company team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.
