Medical Coordinator II Position Available In Miami-Dade, Florida

Medical Coordinator II National Healthcare Solutions, Inc. – 4.3

Miami, FL Job Details Full-time Estimated:

$40.7K – $49.3K a year 12 hours ago Qualifications Writing skills English Mid-level Portuguese Full Job Description About Us We are a dynamic enterprise group of managed care and health insurance service companies which have become industry leaders in their diverse specialties. Headquartered in Dallas, Texas, the group has 10 offices around the world, including the United States, Canada, Panama, Ecuador, Colombia, and Dubai, and employs over 700 employees of various nationalities. Position Summary Analyze pre-authorization requests, monitor incoming emails, and distribute upcoming cases among peers. Handle phone calls from providers, agents, and members, opening cases in the system for further processing and following up throughout the shift. Create and submit letters of guarantee to providers and agents. Track the progress of cases assigned to him/her, as well as those opened by other coordinators during or prior to his/her shift. Reach out to providers via phone or email to inquire about case details, request additional information, and verify the status of cases or patients.

DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

MINIMUM QUALIFICATIONS

(KNOWLEDGE, SKILLS, AND

ABILITIES

) Manages notification, preauthorization and eligibility requests via email from Member, Producers, and Providers for assigned region; handles within given deadline and service objectives. Reviews medical services against policy to determine coverage and exclusions, reads physician information and decides compensability; may request additional information such as medical records to assist in decision making. Coordinates the negotiation of rates with physicians or third parties outside the network for cases over usual and customary rates to ensure cost contention. Create and send letters of authorization and explanations of benefit depending on the outcome of case evaluations to Agents/Clients and Providers. Create and send denial letters to Providers depending on the outcome of case evaluations and coordinate with the Medical Team to send denial letters to Agents/Clients. Coordinates air transfer logistics and authorizations. Enters notes for every conversation, email, and decision in the system so that it is available company-wide. Performs outbound follow-up calls to the provider to verify receipt GOP Performs outbound follow-up calls to clients to verify services were received or if there is anything else needed. Answer inbound calls from Providers, Agents/Clients, as needed, for the coordination of a medical case. Participates in on-call shifts during after-hours, weekends, and holidays, and coordinates emergency cases received during those shifts. May perform other functions as assigned by supervisors. Solid 1-3 years of experience in Health Insurance Claims Service/Precertification area, preferred. Strong English (speech, reading, and writing) is required. (at least Proficiency C1 Portuguese is a plus. Working Conditions General office working conditions, open to hybrid/partial 1-2 day remote in the near future. Work Environment Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function. While performing the duties of this job, the employee will be required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus. Manual dexterity is required to use desktop computer and peripherals. Exposure to variable weather conditions is likely. Travel Requirements This position requires travel to Dallas, Texas, for the first two weeks of employment. NOTE This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.