Medical Review Coordinator

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.

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.

Education/credentials

• High School diploma/GED required
• 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

• Customer focused
• 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.

Working conditions/physical demands

Office environment