Job Description
Founded in 1994 and based in King of Prussia, PA, MedRisk is the leading managed care organization dedicated to the physical rehabilitation of injured workers. With over 1000 employees, we’re a group of talented, driven professionals who strive every day to improve the lives of our clients, our providers and the ultimate stakeholders – the injured workers. We offer an exciting workplace environment plus competitive salaries and benefits. What makes us stand out? It’s the people, the culture we foster and the opportunity to learn and to grow. We encourage you to bring your experience and skills to help us raise the bar.
The following statements are intended to describe the general nature and level of work to be performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of an incumbent.
Position Summary
Compiles, proofs and processes information received from providers/adjusters to aid the Clinical Reviewers to perform clinical reviews. Performs review of service requests, collects non-clinical and structured clinical data, and performs scripted clinical screening that does not require evaluation or interpretation of clinical information. The CSR needs to exhibit the ability to contribute to the overall success of the HES Advocates Team by assisting in the management of continued authorization requests via fax. The CSR must be well organized and have the ability to perform multiple tasks including but not limited to: monitoring assigned caseload and answering and/or researching questions about cases.
Primary Duties & Responsibilities
• Provide excellent customer service skills to internal and external customers via phone, fax, and email
o Work within strict timelines in accordance with the continued authorization process
o Work closely with the Clinical Advocates to manage utilization
o Consistently manage incoming documentation via the Advocate fax line
• Compliance with HIPAA guidelines
• Build relationships through dependable communications between adjusters, NCMs, and our network providers
• Be familiar with client profiles and requirements
• Utilize available licensed health professionals to ensure quality performance of duties
• Maintain compliance with MedRisk policies and procedures
• Meet MedRisk Quality Improvement guidelines
• Complete special projects as assigned
Qualifications
• Minimum associates degree is required.
• Proficiency in Computer usage.
• Prior experience in health related field, knowledge or medical terminology and ICD-9/CPT coding is a plus.
• 2-3 years customer service experience
Internal Job Descriptions
• Impeccable customer service skills
• Ability to multi task in a fast paced environment
• Detail oriented
• Excellent communication skills
• Knowledge of Microsoft Word and Excel
• Computer skills in Windows environment
• Time management and strong organizational skills
Competencies (choose at least 4)
Customer Focus
Action Oriented
Attention to Detail
Priority Setting
Informing
Planning
Working Conditions & Physical Requirements
The work environment characteristics described here is representative of those of a standard office setting. The noise level in the work environment is usually moderate.
While performing the duties of this job, the employee must be able to remain in a stationary position over 50% of the work day; move about inside the office to access files or office equipment; use hands to finger, handle, or feel objects, tools, or controls to operate a computer and other office productivity machines; reach with hands and arms; must communicate and converse with co-workers; and detect/discern information accurately. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must occasionally lift and/or move up to 10 pounds.