Case Fulfillment Coordinator

Nexus is currently seeking to fill a Case Fulfillment Coordinator position at our corporate headquarters in New Braunfels, Texas. This role is an amazing opportunity to grow and diversify your career within the healthcare arena. If you are interested in joining the Nexus team, access our application here.

Employee Application

WHAT WE LOOK FOR:
Ideal candidate is a highly motivated and dynamic individual that thrives in a fast paced environment.

POSITION OVERVIEW:

Title:  Case Fulfillment Coordinator

Job Summary
This position is an administrative position providing the front line of customer service to our clientele.  The right individual will be friendly, efficient, multi-task oriented and detail driven.  This position requires skill in planning, organizing and coordinating the completion of independent medical review, as well as the coordination of day to day office activities.  This position is responsible for working effectively and efficiently to work directly with physician reviewers, supporting them in their daily administrative needs.  This is a highly team oriented position.  The Case Fulfillment Coordinator position requires the ability to utilize a high level of critical thinking, work well under pressure and be deadline driven.

 Essential Job Functions

  • General responsibility for all administrative components of fulfillment work flow process for Utilization Review referrals
  • Routes and coordinates all referrals for prior authorization, concurrent review and retrospective review within the Utilization Review industry
  • Uses discretion and independent judgment in handling patient or physician received documents and routes to appropriate administrative/clinical staff
  • Works directly with physician reviewers maintaining communication regarding daily administrative review tasks
  • Guide physicians to complete time-sensitive deadlines
  • Ensures compliance processes and procedures are adhered to for all state, federal and referral/intake regulatory requirement for Utilization Review
  • Responsible for administrative Quality Assurance component (i.e. templates, completed fields, spelling, grammar, etc.) following completion of physician review
  • Comply with template standards for each client
  • Communicates with Director of Operations any referrals falling outside of standardized process
  • Ensures seamless transition of all completed reviews to end facing client in a time sensitive manner
  • Primary contact for receiving phone calls, managing incoming calls and communications with physician panel
  • Responsible for ensuring proper jurisdictional case requirements, specialty requirements and conflicts of interest are utilized
  • Uses discretion and independent judgment in prioritizing the work flow of all referrals
  • Uses discretion and independent judgment in organizing and assigning time sensitive due dates to all physician panel
  • Responsible for daily case load of a minimum of 75 cases daily
  • Ability to work via web based portal applications
  • Maintain and organize all documentation logs regarding assigned physician reviewers
  • Answer, screen and forward incoming phone calls regarding Case Fulfillment, while providing basic information when needed
  • Ability to be resourceful and proactive in dealing with issues that may arise by working with team and Director of Operations
  • Maintain security by following procedures and controlling access (HIPAA)
  • Support others in a team environment
  • The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job position. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Knowledge and Abilities Requirements:

  • Ability to use Microsoft products; Word, Excel, PowerPoint, Outlook
  • Basic office equipment experience preferred (copier, fax, shipping and receiving tools)
  • Written and verbal communication skills with a demonstrated ability to deliver excellent customer service
  • Communicate professionally with physicians and clients
  • Ability to multi-task and quickly adapt in a fast paced environment
  • Ability to handle difficult/irate callers in a friendly and professional manner
  • Maintain a positive attitude and outstanding customer service while assisting physicians and their offices telephonically
  • Strong organizational skills
  • Attention to detail
  • Professional appearance
  • General Typing Skills at 65wpm
  • Data Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kph
  • Proficiency in English
  • Exemplary planning and time management skills
  • Ability to work in high pressure, deadline driven environment
  • Ability to multitask and prioritize daily workload
  • High level verbal and written communications skills
  • Discretion and confidentiality
  • Demonstrated ability to problem solve complex, multifaceted, situations
  • Ability to engage easily in abstract thought
  • Strong organizational and task prioritization skills

 Education and Experience:

  • High school diploma or equivalent
  • 1-3 years directly related experience in an office based professional setting