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Medical Review Operations Coordinator
2 months ago
Position Summary:
The Case Fulfillment Coordinator plays a vital role in delivering exceptional administrative support and customer service to our clients. The ideal candidate will possess a friendly demeanor, efficiency, and a strong attention to detail. This role involves planning, organizing, and overseeing the independent medical review process while managing daily office operations.
Key Responsibilities:
- Oversee all administrative aspects of the fulfillment workflow for Utilization Review referrals.
- Coordinate and route referrals for prior authorization, concurrent review, and retrospective review within the Utilization Review sector.
- Exercise discretion and independent judgment in managing documents received from patients or physicians, ensuring proper routing to relevant administrative or clinical staff.
- Maintain effective communication with physician reviewers regarding daily administrative tasks.
- Assist physicians in meeting critical deadlines.
- Ensure adherence to compliance processes and procedures for all regulatory requirements related to Utilization Review.
- Conduct administrative Quality Assurance checks, including templates and documentation accuracy, following physician reviews.
- Adhere to template standards for each client.
- Report any referrals that deviate from standardized processes to the Director of Operations.
- Facilitate the timely transition of completed reviews to clients.
- Act as the primary contact for incoming communications, managing calls related to Case Fulfillment.
- Ensure compliance with jurisdictional case requirements and specialty specifications.
- Prioritize workflow for all referrals using independent judgment.
- Assign time-sensitive due dates to the physician panel based on discretion and judgment.
- Manage a daily caseload of at least 75 cases.
- Utilize web-based portal applications effectively.
- Maintain organized documentation logs for assigned physician reviewers.
- Provide basic information and manage incoming calls related to Case Fulfillment.
- Proactively address issues by collaborating with the team and the Director of Operations.
- Uphold security protocols in accordance with HIPAA regulations.
- Foster a supportive team environment.
Required Competencies:
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
- Experience with basic office equipment (copier, fax, shipping tools).
- Strong written and verbal communication skills, demonstrating excellent customer service.
- Professional communication with physicians and clients.
- Ability to multitask and adapt in a fast-paced environment.
- Handle challenging callers with professionalism and friendliness.
- Maintain a positive attitude while assisting physicians and their offices.
- Exemplary organizational skills and attention to detail.
- Typing proficiency of at least 65 words per minute.
- Data entry skills, including 10-key and alpha-numeric entry.
- Strong problem-solving abilities in complex situations.
Minimum Qualifications:
- Punctuality and readiness to work each day.
- Proficient use of computers, printers, and telecommunication devices.
- Ability to communicate professionally with clients and physicians.
- Efficient multitasking under time-sensitive conditions.
- Familiarity with Microsoft Office (2003 or later).
- Willingness to seek assistance when necessary.
- Respect for the organizational structure and workflow.
- Commitment to confidentiality and adherence to company policies.
Disclaimer:
The above statements are intended to describe the general nature and level of work performed by individuals in this role. They are not exhaustive and may include additional responsibilities as required.
