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.
Reports to: Chief Medical Director
Department: Population Health Solutions
Location: Tampa, FL
Additional Responsibilities: Candidate Education:
- 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
Licenses and Certifications:
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 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
A license in one of the following is required:
- Required Intermediate Microsoft Outlook Proficient in Microsoft Office such as Outlook, Word and Excel
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word