Administrative Health Coordinator

: Multiple work schedules, Monday - Friday! Eligible to enroll in Medical plan on date of hire! EXCITING JOB OPPORTUNITY with a rapidly growing organization. This role is an amazing opportunity to grow and diversify your career within the healthcare arena. ABOUT THE COMPANY: Nexus is dedicated to connecting quality physicians with the outcome needs of our partners in the health and legal industries. The heart of our drive for quality and excellence rests in our unflinching integrity; we bend over backwards to provide the best possible service but will never bend our integrity. Nexus realizes that behind the paperwork and reports, there are people, mothers, fathers, sisters, brothers, sons, and daughters. These are people in need of the best, most accurate, medical care possible and we are tasked with ensuring they receive it in a cost-effective manner. We offer competitive compensation and fantastic benefits, as well as a professional workplace in a business casual dress environment. You'll also find plenty of options for professional development and advancement with us as this position allows you to come in and learn our unique approach at offering healthcare cost management solutions. If this sounds like the kind of career move you've wanted to make, and if you meet our qualifications, we want to talk with you! WHAT WE LOOK FOR: Ideal candidate is a highly motivated and dynamic individual that thrives in a fast-paced environment. POSITION OVERVIEW: Title: Administrative Health Coordinator Job Summary This position is an administrative position providing the front line of customer service to our clientele. The right individual will be friendly, efficient, multi-task oriented, and detail driven. This position requires skill in planning, organizing, and coordinating the completion of clinical claims reviews. This position requires a technology literate candidate who will access client portal applications to sort, track, download and process clinical claims reviews. The ideal person should be adept at working under pressure, the ability to be process driven, multi-task oriented and detail driven. This is a highly team-oriented position. The Managed Care Intake position requires the ability to utilize a high level of critical thinking, work well under pressure and be deadline driven. Essential Job Functions

• General responsibility for all administrative components of receiving and processing clinical review requests
• Receives and coordinates all referrals for prior authorization, concurrent review, and retrospective review
• Responsible for review and documentation of client/Case Manager notes to assure proper case routing and review
• Uses discretion and independent judgment in handling patient or physician received documents and routes to appropriate administrative/clinical staff
• Maintains log of incoming reviews by client in time-oriented manner
• Ensures compliance processes and procedures are adhered to for all state, federal and referral/intake regulatory requirement for Clinical Review
• Communicates with Director of Operations any information received outside of standardized process
• Ensures seamless transition of all incoming referrals to the operational floor in a time sensitive manner
• Work in multiple software platforms simultaneously, while maintaining timely workflow process
• Primary contact for receiving phone calls, managing incoming calls and communications with clients
• Responsible for ensuring proper jurisdictional case requirements, specialty requirements and conflicts of interest are utilized
• Uses discretion and independent judgment in prioritizing the workflow of all referrals
• Uses discretion and independent judgment in organizing and assigning time sensitive due dates to all referrals
• Strategizes and plans timely review process to ensure client directives are met
• Utilizes project management skills to strategize workflow
• Responsible for daily case load of a minimum of 65 cases daily
• Maintain and organize all documentation logs regarding daily case load
• Answer, screen, and forward incoming phone calls regarding Case Intake, while providing basic information when needed
• Ability to be resourceful and proactive in dealing with issues that may arise by working with team and Director of Operations
• Maintain security by following procedures and controlling access (monitor logbook, HIPAA)
• Support others in a team environment
• The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job position. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Knowledge and Abilities Requirements:

• Professional appearance
• Excellent knowledge of MS Office
• Ability to work in dual screen environment
• General Typing Skills at 65wpm
• Data Entry 10 Key Skills at 10,000kph / Data Entry Alpha Numeric Skills at 10,000kph
• Proficiency in English
• Exemplary planning and time management skills
• Ability to work in high pressure, deadline driven environment
• Ability to multitask and prioritize daily workload
• High level verbal and written communications skills
• Discretion and confidentiality
• Demonstrated ability to problem solve complex, multifaceted, situations
• Ability to engage easily in abstract thought
• Strong organizational and task prioritization skills

Education and Experience:

• High School diploma or equivalent; college degree preferred

• 5+ years directly related experience in an office based professional setting