HS Review Coordinator II

Medica's Review Coordinator II is responsible for coordinating and supporting all intake functions into the Utilization Management and Clinical Appeals Department in accordance with all department policies, regulatory and accreditation requirements.

Key Elements:

• Triage, research and enter- prior authorization requests that require a clinical review
• Triage, research and enter appeal requests that require a clinical review
• Triage, research and enter acute inpatient hospital admissions
• Triage, research and enter member administrative referrals
• Triage, research and complete non-clinical service requests
• Outreach attempts to providers requesting clinical or additional information needed for the
  requested reviews
• Research and resolution of provider and member questions and issues while maintaining a
  positive customer relationship

This is a critical role at Medica, as downstream activities, such as pre-service and post-service

authorizations and clinical appeals depend upon the timely, accurate processing of information to perform their job functions and ensure regulatory and accreditation standards are met.

This role has the opportunity to work hybrid or remote. We are currently seeking candidates that reside in AZ, AR, DE, FL, GA, IA, IL, KS, MD, ME, MI, MN, MO, ND, NE, NV, OK, SD, TN, TX, VA, and WI.

Qualifications:

• High School Diploma or Equivalent; Associate's or Bachelor's degree preferred
• 2+ years of healthcare industry experiencewithin a professional customer service or administrative type function
• Knowledge of prior authorization processes preferred, however not required

Skills and Abilities:

• Advanced data entry skills
• Strong verbal and written communication
• Strong organizational and time management skills
• Ability to manage multiple tasks and priorities
• Analytical and critical thinking skills
• Ability to work with limited supervision
• Attention to detail and accuracy are critical
• Excellent computer skills

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)