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
- 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.
- Required a High School or GED
- Preferred an Associate's Degree in a related field
- 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
- 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
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word