Case Fulfillment Coordinator (On-site) at Nexus Enterprises LLC

Schertz, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

06 Jan, 26

Salary

0.0

Posted On

08 Oct, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Microsoft Office, Customer Service, Multi-tasking, Organizational Skills, Attention to Detail, Typing Skills, Data Entry, Communication Skills, Problem Solving, Planning, Time Management, Discretion, Confidentiality, Team Support, Critical Thinking, Adaptability

Industry

Business Consulting and Services

Description

Description Job Summary This position is an administrative position providing front line 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 workflow 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 workflow 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. Competencies: Ability to use Microsoft products; Word, Excel, PowerPoint, Outlook Use of basic office equipment experience (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 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 Requirements Minimum Requirements: Utilize office equipment (computer, printer, fax, and telephone) in a professional manner General Typing Skills at 65wpm or better Data Entry 10 Key Skills at 5,000kph / Data Entry Alpha Numeric Skills at 10,000kph Communicate professionally with physicians and clients Multi-task and work efficiently under time sensitive pressure Familiarity with Microsoft Office 2003 (or more recent) Ask for help when needed Support others in a team environment Observe and respect the organizational flow of the office Position Demands: This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, team members, and vendors and must be able to exchange accurate information. Equal Employment Opportunity: The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and Human Resources Department. Discrimination and harassment will not be tolerated. We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply. Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All company team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Responsibilities

The Case Fulfillment Coordinator is responsible for managing the administrative components of the fulfillment workflow process for Utilization Review referrals and coordinating day-to-day office activities. This role involves working directly with physician reviewers and ensuring compliance with regulatory requirements while maintaining effective communication.