Case Fulfillment Coordinator (On-Site)

Nexus•Schertz, TX

10d•Onsite

About The Position

This Case Fulfillment Coordinator 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.

Requirements

Ability to use Microsoft products: Word, Excel, PowerPoint, Outlook
Basic office equipment experience is preferred
Written and verbal communication skills with a demonstrated ability to deliver excellent customer service
Communicate professionally with physicians and clients
Ability to multitask 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 provide outstanding customer service while assisting physicians and their offices telephonically
Strong organizational skills
Attention to detail
General Typing Skills at 65wpm
Data Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kph
Proficiency in English (reading, speaking, and writing)
Exemplary planning and time management skills
Ability to multitask and prioritize daily workload
High-level verbal and written communication 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
High school diploma or equivalent
1-3 years directly related experience in an office-based professional setting

Responsibilities

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 components (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 clients 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 panels
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