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Corporate Functions & Operations WellCare - Coding & Records Careers

Medical Review Coordinator Job

Full Job Title: Medical Review Coordinator

Job Number: 1804280

Location: Phoenix, AZ

Date Posted: 7-2-2018

Provides administrative and departmental support for Medical Directors. Provides oversight on MD workflow, clinical reviews and assists in completing activities related to cross functional projects.

DEPARTMENT: Health Services-Medicaid

REPORTS TO: Manager, Medical Review Coordination

Essential Functions:

  • Reviews MD workflow queue in medical management system and makes adjustments to workflows as needed.
  • Manage turn-around-times for authorizations that require review by a Medical Director.
  • Provides support for the adverse determination process which includes ensuring notification meets regulatory/contractual requirements for content and timeliness.
  • Acts as subject matter expert in regards to required departmental best practices, reports and data extracts.
  • Conducts research, including reviewing member records, and organizes documentation to report findings in support of Medical Directors.
  • Responds to phones as assigned or team coverage as directed by Medical Directors.
  • Serves as a liaison in corresponding and communicating with providers, vendors and WellCare contacts and/or members' representatives.
  • Organizes a variety of administrative and clinical tasks and prioritizes in order of importance and impact on members and providers.
  • Manage all communications that are utilized between clinical staff, Medical Director and providers.
  • Performs other duties and special projects as assigned.
Candidate Education:
  • Required a High School or GED
  • Preferred an Associate's Degree in a related field
Candidate Experience:
  • Required 3 years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties
  • Required 1 year of experience in directly supporting clinicians
Candidate Skills:
  • Intermediate knowledge of medical terminology and/or experience with CPT and ICD-9/10 coding
  • Intermediate demonstrated interpersonal/verbal communication skills
  • Intermediate demonstrated written communication skills
  • Intermediate ability to effectively present information and respond to questions from peers and management
  • Intermediate ability to multi-task
  • Intermediate ability to work as part of a team
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word

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Last Updated On: 12/9/2015