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Advanced Medical Reviews · 2 weeks ago

Case Coordinator

Long Beach, CA 90806

Full-time

Onsite

Entry Level

$19/hr - $19/hr

2+ years exp

Advanced Medical Reviews is seeking a Case Coordinator responsible for ensuring reports meet high standards of quality and compliance with various regulations. This role involves quality assurance reviews and providing support to the Quality Assurance Department.

Health CareMedical

Diversity & Inclusion

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

Promotes effective and efficient utilization of company resources

Participates in various educational and or training activities as required

Performs other duties as assigned

Qualification

Quality assuranceMedical terminologyClinical citationsInsurance industry knowledgeMicrosoft OfficeCommunication skillsTime managementTeam-orientedConfidentiality

Required

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 of more of the following categories: workers compensation, no-fault, liability, and/or disability

Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values

Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages

Must be a qualified typist with a minimum of 40 W.P.M

Must be able to operate a general computer, fax, copier, scanner, and telephone

Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet

Must possess excellent skills in English usage, grammar, punctuation and style

Ability to accurately follow instructions and respond to directions from upper management

Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met

Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed

Must be able to work independently, prioritize work activities and use time efficiently

Must be able to maintain confidentiality

Must be able to demonstrate and promote a positive team-oriented environment

Must be able to stay focused and concentrate under normal or heavy distractions

Must be able to work well under pressure and or stressful conditions

Must possess the ability to manage change, delays, or unexpected events appropriately

Demonstrates reliability and abides by the company attendance policy

Must maintain a professional and clean appearance at all times consistent with company standards

Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements and legal contracts and documents

Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar

Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community