Medical Case Specialist I

JOB SUMMARY:



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:



* Answer phones from automated call distribution system

* Triage daily download of referrals and ensure appropriate worksheets are assigned to corresponding conditions as identified by Veterans 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:



* 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.



EXPERIENCE



Required



* 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



EDUCATION



Required



* High School Diploma or better

* GED or better



LICENSES & CERTIFICATIONS



Preferred



* Medical Assistant

* Certified Medical Coder

* Certified Nursing Asst



SKILLS



Required



* 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



BEHAVIORS



Preferred



* 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



MOTIVATIONS



Preferred



* 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 contractors legal duty to furnish information. 41 CFR 60-1.35(c)