Case Fulfillment Coordinator (On-site)

Job Description

Job Description

Description : 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 :

• 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 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 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 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 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 job position. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Competencies :

Requirements :

Minimum Requirements :

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 :

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.