POSI T I O N P URP O SE:

The Medical Coordinator reviews requests for the evaluation and authorization of medical services. The ideal candidate will be able to work independently and make judgement calls. He/she will have direct interaction with members, agents or providers and will need to become knowledgeable of policy benefits; ICD/CPT codes in order to properly evaluate cases and answer questions. The desire of providing excellent client service is a fundamental requirement of this position. The person will work under the supervision and guidance of the Medical Admin Supervisor

ESSE N T IA L JOB DUTIES AND RESPONSIBILITIES:

• Acts autonomously and requests medical information for the authorization of medical services. Follows existing guidelines procedures and standards when reviewing medical cases (ICD-10, Encoder and Physicians Fee/coding guide),
• Provides explanations of benefits via phone, email and Live Chat. Gives policy benefits when required and requests necessary documentation for the evaluation of services.
• Monitor emails received in Precert inbox, ensuring that emails are answered professionally and within the established 24-48-hour time frame.
• Evaluate medical fees for cost control while following the Usual Customary and Reasonable (UCR) fee schedule and steering guidelines. Negotiate with providers and doctors if fees exceed UCR for the services described.
• Provides exceptional service while ensuring that emails are answered within 24-48 hours, service level is maintained above 90% and authorizations are issued without errors.
• Ability to work independently or as part of a team. Able to make judgement calls
• Attention to detail and ability to multi task
• Work the after-hours on call schedule as required
• Follows up on pending cases. Issues authorizations or denials as required

Qualifications

DESIRED MINIMUM QUA L I F I C A T I O NS:

• The ideal candidate will demonstrate a passion for being service oriented, prompt and courteous; have a positive, customer-focused attitude and demonstrated adaptability to changes
• Ability to express verbally and in writing clearly and succinctly in English and Spanish
• Able to cope with stressing situations
• Special attention to detail and self-motivation
• Excellent follow-up and organizational capabilities
• Ability to maintain a balanced workload and prioritize accordingly
• Ability to work well individually and with others as part of a team
• Must exercise consistent judgment and discretion as his decisions by approving cases may impact the company financially
• Proficient with computers, MS Office (Email, Excel, Word) and office equipment (fax, copier, phone).
• Ability to handle high volume of calls/emails
• Excellent Organizational skills
• Medical terminology knowledge is a plus

EDUCATION AND EXPERIENCE:

• A minimum of one (1) year of experience working in an administrative position or providing customer service in fast-paced entrepreneurial company
• College education required
• One (1) year of experience working in a medical administrative position in the U.S. medical system is a plus (experience could be from having worked in an insurance company, as office manager or similar position in a hospital or physicians office).
• Opportunity for on the job training may be available based on previous experience