ExamWorks - Phoenix, AZ

posted 11 days ago

Full-time - Entry Level
Phoenix, AZ
Ambulatory Health Care Services

About the position

ExamWorks is looking for a Case Coordinator to join our Phoenix, AZ office. This person is detail-oriented, organized, possesses exceptional communication skills, and is eager to learn new things! As a Case Coordinator, you will be responsible for ensuring reports are of the highest quality and integrity and in full compliance with client contractual agreements, regulatory agency standards, and/or federal and state mandates. This position is required to assist with quality assurance questions and provide overall support to the Quality Assurance Department. This role is a full-time in-office position with a standard work schedule Monday-Friday 8:30am to 5:00pm.

Responsibilities

  • Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
  • Ensures the provider credentials and signature are adhered to the final report.
  • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
  • Assists in resolution of customer complaints and quality assurance issues as needed.
  • Ensures all federal ERISA and/or state mandates are adhered to at all times.
  • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
  • Promote effective and efficient utilization of company resources.
  • Participate in various educational and or training activities as required.
  • Perform other duties as assigned.

Requirements

  • High school diploma or equivalent required.
  • A minimum of two years clinical or related field experience; or equivalent combination of education and experience.
  • Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.
  • Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
  • Qualified typist with a minimum of 40 W.P.M.
  • Ability to operate a general computer, fax, copier, scanner, and telephone.
  • Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Excellent skills in English usage, grammar, punctuation and style.
  • Ability to follow instructions and respond to upper management's directions accurately.
  • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
  • Exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
  • Ability to work independently, prioritize work activities and use time efficiently.
  • Ability to maintain confidentiality.
  • Ability to demonstrate and promote a positive team-oriented environment.
  • Ability to stay focused and concentrate under normal or heavy distractions.
  • Ability to work well under pressure and/or stressful conditions.
  • Ability to manage change, delays, or unexpected events appropriately.
  • Demonstrates reliability and abides by the company attendance policy.
  • Maintain a professional and clean appearance at all times consistent with company standards.

Benefits

  • Competitive benefits
  • Paid time off
  • 401k
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