- 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 administrativereview tasks
- Guide physicians to complete time-sensitive deadlines
- Ensures compliance processes and procedures are adhered to for all state, federal andreferral/intake regulatory requirement for Utilization Review
- Responsible for administrative Quality Assurance component (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 client in a time sensitive manner
- Primary contact for receiving phone calls, managing incoming calls and communications withphysician panel
- Responsible for ensuring proper jurisdictional case requirements, specialty requirements andconflicts 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 allphysician panel
- 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 basicinformation when needed
- Ability to be resourceful and proactive in dealing with issues that may arise by working with teamand 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 job position. The incumbents may be requested to perform job-related tasks other than those stated in this description.
- 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 outstanding customer service while assisting physicians and theiroffices telephonically
- Strong organizational skills
- Attention to detail
- Professional appearance
- 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
- Arrive at work on time and ready to work every workday
- Utilize a computer, printer, fax, and telephone in a professional manner
- General Typing Skills at 65wpm or better
- Data Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kph
- Communicate professionally with physicians and clients
- Multi-task and work efficiently under time sensitive pressure
- Familiarity with Microsoft Office 2003 (or more recent)
- Ask for help when needed
- Support others in a team environment
- Observe and respect the organizational flow of the office
- Sign and abide by the confidentiality agreement and ProPeer Employee Handbook
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Case Fulfillment Coordinator - Schertz, United States - Nexus
Description
Job Description
Job DescriptionDescription:Job Summary
This position 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
Competencies:
Minimum Requirements:
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 ProPeer employees may be required to perform duties outside of their normal responsibilities from time to time, as needed.
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