Medical Case Specialist I-AWW (Thurs-Sunday)
QTC Management, Inc.
Case Specialist Job in Hico, TX
Under limited supervision, performs a variety of activities in support of a specific project/business/technical unit. Gathers, collects, records, tracks and verifies data and information from multiple sources. Uses software for functional area to schedule appointments and document in the case management systems. Compiles and generate reports, statistics, timelines, tables, graphs, correspondence and presentations. Provides data and information to others on functional unit processes and procedures. Delivers exceptional customer service at all customer touch points.
Essential Duties and Responsibilities:
Must have the ability to work from Thursday to Sunday.
Answer phones from automated call distribution system
Triage daily download of referrals and ensure appropriate worksheets are assigned to corresponding conditions as identified by Veteran's Administration
Verify appropriate CPT and CLIN codes are assigned to each case
Communicate directly with claimants and providers
Obtain medical history for specific conditions
Determine appropriate examinations, tests and specialists required for each case
Schedule appointments for examinees including follow-up appointments and rescheduled appointments
Ensure all examinees and providers receive necessary documentation
Confirm consultative reports and diagnostic test results are received in a timely manner
Meet or exceed contract timeliness guidelines in both the scheduling and case management systems
Other projects and duties as assigned
Competencies:
Proven ability to plan and organize work load
Ability to manage competing priorities in a fast paced work environment
Good follow through skills
Must possess the ability and flexibility to work early morning, evening, and/or weekend shifts
Education and/or Experience:
High School diploma, or equivalent (GED) or 2 years of additional relevant experience in lieu of diploma/GED
Must be able to successfully pass National Agency Check with Inquiries (NACI) background investigation
This job description supersedes all prior job descriptions and is intended to describe the general content and essential requirements for the position listed above. It is not to be construed as an exhaustive statement of requirements, duties and responsibilities. Management reserves the right to add or change the duties of this position as required at any time.
QTC Management Inc. is a VEVRAA Federal contractor and an Equal Opportunity Employer. The company has an ongoing commitment to affirmative action and the creation of a workplace free of discrimination, harassment and retaliation. The company recruits, hires, trains, and promotes individuals in all job titles without regard to race, color, creed, religion, ancestry, national origin, age, sex, sexual orientation, people with disabilities protected under law, and protected veteran status.
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ExperienceRequired
Less than 1 year(s): Experience in healthcare, medical, or insurance related industries
Preferred
Direct healthcare experience in medical case management or quality assurance to include the review of complex multi-focal medical reports for quality, clarity, thoroughness and insightful medical explanation
Experience with electronic medical scheduling and case management software
EducationRequired
High School Diploma or better
GED or better
Licenses & CertificationsPreferred
Medical Assistant
Certified Medical Coder
Certified Nursing Asst
SkillsRequired
Written Communication
Verbal Communication
Computer Literacy
Preferred
Problem Solving
Medical Documentation
Customer Service
Multi-line phone
MS Office
Medical Scheduling Software
Medical Terminology
Medical Data Entry
Electronic Medical Records
BehaviorsPreferred
Enthusiastic: Shows intense and eager enjoyment and interest
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Team Player: Works well as a member of a group
Innovative: Consistently introduces new ideas and demonstrates original thinking
MotivationsPreferred
Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work
Goal Completion: Inspired to perform well by the completion of tasks
Job Security: Inspired to perform well by the knowledge that your job is safe
Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
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)