Medical Coordinator

National Healthcare Solutions Group LLC•Miami, FL

2h•Onsite

About The Position

A Medical Coordinator acts as the client's advocate and guide through the preauthorization process, ensuring medically necessary care is approved efficiently while providing clear, compassionate support at every step. This role involves managing preauthorization requests, assessing medical necessity, coordinating with providers, interpreting policy coverage, and supporting case management. The coordinator also plays a role in cost containment, compliance, and communication with various stakeholders, including handling emergency situations and maintaining accurate records.

Requirements

Associate’s degree or higher.
Proven abilities in oral and written communication and speak clearly and persuasively in positive or negative situations.
Excellent written and verbal skills.
Strong interpersonal and presentation skills to successfully interact with leadership and staff; brokers; agents; employers and their members.
Proficient in MS Office Suite.
Organized with the ability to prioritize and plan.

Nice To Haves

Spanish – English preferred.
Portuguese is a highly appreciated plus.

Responsibilities

Act as the main point of contact for members during the preauthorization and care journey.
Represent the client’s best interests when liaising with providers and any other stakeholder involved in customer care.
Support clients in coordination of appointments, services and navigating complex or urgent medical situations.
Manage notification, preauthorization and eligibility requests via phone and email from Member, Producers, Providers, Physicians or authorized third party for assigned region.
Assess medical necessity in line with policy terms and clinical guidelines.
Ensure timely and high-quality decisions to avoid delays or disruptions in care.
Generate authorization or denial letters based on case review.
Analyze medical reports, treatment plans, and provider recommendations.
Request additional information to providers or other owner of information when needed to support decision-making.
Ensure accuracy and completeness of medical records.
Communicate with hospitals, clinics, and physicians worldwide.
Facilitate direct billing arrangements.
Coordinate logistics for admissions, treatments, and follow-ups.
Explain benefits, exclusions, and coverage limits to clients and providers.
Ensure that requested services align with the members’ policy.
Help manage expectations regarding approvals and financial responsibility.
Escalate or draw attention to complex cases (e.g., chronic conditions, high-cost treatments).
Ensure continuity of care across multiple providers or countries through a proactive approach.
Make follow-ups calls to clients and agents to verify client status and proactively identify new needs.
Negotiate rates with physicians or third parties for cases over usual and customary rates to ensure cost contention.
Promote cost-effective treatment options without compromising quality. Offer alternatives.
Ensure adherence to insurer policies, clinical protocols, and regulatory requirements.
Identify potential fraud, waste, or abuse.
Serve as the link between clients, brokers, providers, and internal teams.
Provide clear, timely updates on case status and decisions.
Manage expectations and resolve queries or complaints from any stakeholder.
Support members during medical emergencies. Sense of urgency and empathy.
Coordinate urgent admissions and evacuations if required.
Ensure immediate and appropriate care access.
Maintain accurate case records and documentation in internal systems.
Track authorizations, approvals, and outcomes.
Contribute to reporting, audits, and quality improvement initiatives.
Create the necessary alerts with the team to ensure continuity of care.
May perform other functions as assigned by supervisors.