Care Coordinator

About The Role

Brighton Health Plan Solutions provides Utilization Review/Case Management/Medical Management/Claims Review services to its clients. Care Coordinators facilitate care management and utilization review by performing data collection & data entry, and effectively communicating with Nurse Case Reviewers/Managers, employers and claimants in regards to claimants' workers' compensation cases. Provide claims processing for the Workers' Compensation and No Fault lines of business. The successful candidate will be afforded an opportunity to help further structure this team. This team is a critical component to the delivery of quality healthcare services. Primary Responsibilities

• Collect data from claimant representative, physician, or hospital; verify claimant case status and provider network status.
• Set up cases in system in accordance with departmental workflows, policies and procedures.
• Assist Nurse Case Reviewers with non-clinical issues tasks such as requesting clinical information from providers, obtaining necessary forms, and confirming work status.
• Enter required case demographics and transcribe clinical information.
• Handle incoming group phone calls and interact with employers, employees, physicians and insurance adjusters to gather information about medical status, and/or type of care needed in a timely manner.
• Schedule medical appointments for members with in-network facilities and providers and coordinate/verify member attendance at the appointment.
• Maintain and update all activity trackers within designated timeframes.
• Verify and ensure the accuracy of claimant cases; create, scan, fax, mail, and upload correspondence and documentation as needed.
• Follow established quality assurance standards and all policies and procedures.
• Report and document any concerns, complaints and/or issues with direct supervisor.
• Demonstrates a kind, caring, sympathetic and positive attitude with all customers and fellow employees.
• Perform Ad-Hoc projects and support departmental initiatives as needed.

Essential Qualifications

• Superior oral and written communication skills.
• Strong PC skills (Excel is a must).
• Excellent organizational skills.
• Ability to maintain professional demeanor under pressure.
• Ability to work independently and as a team player.
• Minimum of one years' experience in the medical field.
• Bachelor degree or equivalent experience.
• Bilingual preferred, but not required.
• Previous experience in case management handling insurance claims a plus.
• Strong skills in medical record review.
• Familiarity with medical terminology.
• Current knowledge of workers compensation and legislative issues a plus.