Case Coordinator

Advanced Medical Reviews, Inc.; Long Beach (CA); Vor Ort; USD 55.000 - 75.000; Vollzeit

Benefits dieser Stelle

Medical benefits

Vision benefits

Dental benefits

401k

Zusammenfassung

Advanced Medical Reviews, Inc. is seeking a Case Coordinator to ensure high-quality, compliant reports and robust quality assurance support for the QA Department.

The role involves QA reviews, evidence-based rationales, and adherence to client specifications, IRSA/state mandates, and professional standards. Responsibilities include coordinating with peer reviewers, maintaining documentation integrity, and assisting in resolving client inquiries and issues while upholding confidentiality and team

Qualifikationen

• High school diploma or equivalent required.
• Minimum two years clinical or related field experience or equivalent.
• Knowledge of the insurance industry preferably claims management related to 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 operate a computer, fax, copier, scanner, and telephone.
• Must be a qualified typist with a minimum of 40 WPM.
• Excellent English usage, grammar, punctuation and style.

Aufgaben

• Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
• Ensures evidence-based rationales support recommendations and determinations.
• Ensures client instructions and specifications are followed and questions addressed.
• Cites current, reputable medical literature to support references.
• Maintains high quality content, format, and professional appearance of reports.
• Ensures appropriate board specialty review and accurate documentation.
• Verifies peer reviewer attestation and absence of conflicts of interest.
• Ensures provider credentials and signature are on the final report.
• Identifies inconsistencies and seeks clarification or corrections as needed.
• Assists in resolution of customer complaints and QA issues.
• Ensures ERISA/state mandates are adhered to at all times.
• Provides guidance to management on quality, consultant availability, and compliance.
• Promotes efficient use of company resources.
• Participates in training activities and other duties as assigned.

Kenntnisse

Medical terminology

Anatomy & physiology

Attention to detail

Communication skills

Time management

Discretion/confidentiality

Typing 40 WPM

Independent work

Team collaboration

Ausbildung

High school diploma or equivalent

Two years clinical or related field experience

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

Internet

Jobbeschreibung

SUMMARYThe Case Coordinator is responsible to ensure reports are of the highest quality and integrity and in full compliance with client contractual agreement, 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.ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING (Core 25-D):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.EDUCATION AND/OR EXPERIENCEHigh 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.QUALIFICATIONSMust 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.MMust 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.WHO WE AREAdvanced Medical Reviews (AMR) is setting the industry standard in providing quality independent medical reviews and physician-level peer review services that are timely, customizable and affordable. AMR offers a single-source solutions for all of our clients' medical and billing review needs covering all specialties and subspecialties nationwide. Our proprietary technology and strong quality assurance ensures the highest quality standards throughout the review process.WHO WE AREAdvanced Medical Reviews (AMR) is setting the industry standard in providing quality independent medical reviews and physician-level peer review services that are timely, customizable and affordable. AMR offers a single-source solutions for all of our clients' medical and billing review needs covering all specialties and subspecialties nationwide. Our proprietary technology and strong quality assurance ensures the highest quality standards throughout the review process.Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.Equal Opportunity Employer - Minorities/Females/Disabled/VeteransAdvanced Medical Reviews offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k