Medical Office Coordinator
1 month ago
Job Title: Medical Office Coordinator
Job Summary:
The Medical Office Coordinator provides effective communication between MSO, IPA providers, and health plan representatives to coordinate member care. This role involves ensuring accessibility to care, validating contracts, and modifying requests while meeting timeliness standards.
Key Responsibilities:
- Process daily web inquiries and provide written communication
- Identify providers who require educational support on State, Federal, and plan requirements
- Forward referral requests to clinicians for review as needed
- Respond to web inquiry submissions within UM department turnaround time
- Modify requests according to coordinator hierarchy grid
- Communicate effectively with internal and external sources
- Process authorization requests within state and federal timeliness regulations
- Research member history for duplication requests
- Request medical records according to requested services
- Validate data entry for errors
- Verify member benefits and eligibility upon web inquiry receipt
- Utilize authorization matrix, ancillary rosters, DOFR, and delegation agreements
- Coordinate with referral clinicians and medical directors for timely processing
- Maintain knowledge of CMS & Medi-Cal policy guidelines
- Identify and inform case management clinicians on complex care diagnoses
- Screen cases for possible California Children Services (CCS) eligible conditions
- Collaborate with other departments to resolve member/provider matters
- Data entry for additional requested services
- Assist with special projects and other team members as needed
- Regular attendance at UM team meetings
Requirements:
- High School graduate or GED equivalent
- One-year medical office experience
- Knowledge of medical terminology
- Proficiency in Microsoft Office programs, especially Word and Excel
- Proficiency in EZCAP a plus
Skills and Abilities:
- Ability to multitask in a fast-paced environment
- Reliable, dependable, and accountable
- Strong customer service skills with good telephone rapport
- Ability to empathize with complex cases
- Self-motivation and ability to work independently
- Great critical thinking and problem-solving skills
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