Patient Care Coordination Specialist

Concentra, Inc.; Addison, Northern (TX, KY); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Concentra, Inc. is seeking a detail-oriented Medical Review Coordinator to manage medical necessity requests, coordinating with physician advisors to ensure timely determinations in line with state guidelines.

You will review submissions for completeness, maintain confidentiality, and support customers with clear communication, while upholding Concentra policies. This full-time role requires excellent written and verbal communication, ability to handle sensitive information, and a commitment to

Qualifications

• 1-3 years customer service experience required
• Prefer telephone call center and/or medical office experience
• Experience with medical terminology, CPT/ICD codes preferred

Responsibilities

• Directly communicates with customer and physician advisor and tracks cases to ensure case is completed and returned to customer within established time requirements.
• Receives and reviews physician review requests to ensure that all necessary information is available and contacts customer if additional information is required.
• Assigns cases to appropriate/qualified physician advisor based on case requirements for specific physician specialty, experience, and state licensure requirements.
• Upon receipt of completed determination, reviews for spelling and grammatical errors, appropriate application of state guidelines, ensures that all questions have been addressed, and releases the final determination to requesting customer.
• Ensures a case is completed and returned to customer based on promised return date.
• Works any assigned physician review queue and/or communications queue.
• Seeks assistance of more experienced Physician Review Coordinator (PRC) or Supervisor to troubleshoot problem cases.
• Responds appropriately to customer or provider complaints. Refers complaint calls to Supervisor, QA Manager, or Director.
• Performs other duties as assigned.

Skills

Team oriented

Telephone etiquette

Customer service

Confidential information

Microsoft Word/Excel

Written/oral communication

Time management

Education

1-2 years college

Medical Assistant/Medical Records cert

Tools

None

Job description

Concentra, Inc. is seeking a detail-oriented Medical Review Coordinator to manage medical necessity requests, coordinating with physician advisors to ensure timely determinations in line with state guidelines.

You will review submissions for completeness, maintain confidentiality, and support customers with clear communication, while upholding Concentra policies. This full-time role requires excellent written and verbal communication, ability to handle sensitive information, and a commitment to