Patient Coordinator

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

From our Dallas corporate headquarters to our clinics, worksites, and mobile locations, Concentra colleagues remain focused on our driving purpose: to provide superb patient and employer experience by delivering the highest quality healthcare in an efficient, affordable, caring manner. We do this by putting all customers (internal and external) first and by displaying:

• A healing focus
• A selfless heart
• A tireless resolve

Position Summary

Working from instructions and pre-established guidelines, under general supervision, assigns medical necessity requests to a qualified reviewer and follows-up to ensure timely determination is delivered based on state/URAC guidelines in accordance with Concentra policies, practices and procedures.

This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Concentra is an Equal Opportunity Employer M/F/Veterans/Disabled

Concentra is an equal opportunity employer that prohibits discrimination, and will make decisions regarding employment opportunities, including hiring, promotion and advancement, without regard to the following characteristics: race, color, national origin, religious beliefs, sex (including pregnancy), age, disability, sexual orientation, gender identity, citizenship status, military status, marital status, genetic information, or any other basis protected by federal, state or local fair employment practice laws.

Responsibilities

The Details

• Communicates directly 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.

Qualifications

Education/credentials

• 1-2 years college preferred
• Medical Assistant or Medical Records certification preferred

Job-related experience

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

Job-related skills/competencies

• Team oriented
• Good telephone etiquette and customer service orientation
• Ability to handle confidential information
• Knowledge of Microsoft Word and Excel and ability to learn new software applications.
• Team oriented
• Strong written, oral and interpersonal communication skills
• Ability to manage time effectively, set priorities, accommodate multiple demands for time and resources.