Case Review Specialist

3 weeks ago

Rockville, United States STG International Full time

STG International is currently seeking a **Case Review Specialist** for Federal Occupational Health Services in Rockville, MD.

Job Specific Duties and Responsibilities:
Provide direct support to the mission of Federal Occupational Health (FOH), a component of the Program Support Center (PSC), to improve the health, safety, and productivity of the Federal workforce by performing fulfillment of case review activities (review of service and provider fulfillment), interacting with internal and external customers regarding questions and clarification of services or other communication essential to the maintenance of the agreement and coordinating service delivery with FOH Business Operations team. Serves as Case Review Specialist for the case review process to include ensuring exam scheduling, appropriate management and processing of all medical records, Quality Assurance (QA) is completed on exams according to the Interagency Agreement (IAA) and the Case Review Processing Order, complete exams are sent to the RMO for review, timely and secure transmission of the Reviewing Medical Officer (RMO) determinations to the customer agency and their employees (as applicable). Enter charges for exams and administrative fees to cost recover.

Other duties may include outreach to clinics to retrieve missing exam items, work with Occupational Health Clinics (OHC) to ensure all portions of exam completed are billed for appropriately, collaborate with FOH team members to ensure workflow facilitates the customer needs are met, relay any concerns raised by customers to Program Manager (PM).
- Ensure exam scheduling requests are submitted timely and appointment notifications are tracked in accordance with the designated time frame.
- Retrieve exams for case review processing.
- Track exams and ensure exam processing is fluid and timely.
- Enter data on RMO Timesheets
- Ensure medical reviews and exams are sent securely.
- Participate in cost recovery efforts.
- Update fulfilment tickets.
- Professionally communicate with internal and external customers

Quality and Safety
- Ensure case review processing timeframes and quality assurance parameters are met as directed by the Program Manager (PM) before cases are forwarded to an RMO for review and/or to the agency.
- Attend all mandatory trainings.
- Demonstrate understanding of the Case Review processing, work to learn new workflows and processes.
- Display competencies in all areas of case review.

Service Operations
- Ensure scheduling requests are submitted within 24 hours of receipt to the appropriate OHC or through the Private Network Provider (PPN).
- Ensure medical records are retrieved using the PPN portal daily and the internal electronic file storage. Outreach to OHC clinic to request records after exam completion. Follow up on any missing exam items timely and track to ensure received completely and entered in tracking system.
- Ensure exams are processed timely to meet the requirements of FOH. Upon receiving a complete exam, QA, send to the RMO (if applicable), complete data entry/tracking, and send RMO determination to agency.
- Escalate missing exam items to PM when items are not received.
- Transmit exams according to IAA specifics and dates tracked.
- Report all privacy and security breaches immediately according to FOH and HHS policy.
- Attend all meetings with team and internal customers as directed.

Procurement
- Coordinate with Business Operations team to provide customer services (e.g., exams, outreach, etc.) through FOH OHCs and the PPN.
- Assist with implementing new case review business and changing requirements for existing business when new agreements are initiated or if an existing agreement is modified.

Cost Recovery
- Ensure RMO and admin billing is completed, review any discrepancies, and notify PM.
- Review PPN invoices each month, identify discrepancies, and correct billing as needed.
- Ensure all billing items have been entered correctly and timely, concurrently when reviewing exams.
- Demonstrate a complete understanding of the current database used for billing, RMO reviews and exam tracking.

Staffing and Reporting Relationships
- Be on time to work and work all designated hours as determined by PM.
- Request leave according to specified timeframes with vendor and PM.
- Adhere to telework policy when permitted.
- Create a climate of trust, accountability, and professionalism. Report to PM staffing concerns which can affect productivity and morale.
- Identify and report problems with hardware, telecommunications or other issues impacting duties to PM.

Technology
- Fully knowledgeable and proficient in IT systems, for database tracking, billing, and other deliverables, to include but not limited to Microsoft Word, Excel, Outlook, and Adobe Acrobat.
- Attends training on IT systems and completes mandatory IT training by specified deadlines.
- Inform PM of IT and other equipment needs, particularly those that prevent completion of case review pro

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