Job Description
MONDAY - FRIDAY WORK SCHEDULES!
EXCITING JOB OPPORTUNITY! Nexus is a rapidly growing organization still led by its founders, with the same vision and culture that have powered success for our clients and growth for our company and our employees. This role is an amazing opportunity to grow and diversify your career within the healthcare arena.
ABOUT THE COMPANY: Innovation In Independent Clinical Review
From our headquarters in Schertz, TX, Nexus is delivering on a new vision for independent clinical review and utilization management. The innovative NEXUS platform provides faster, more accurate, and more reliable evidence-based clinician reviews from an advisory panel of over 1000 physician experts.
Nexus has assembled a leadership team with diverse backgrounds and expertise in support of our mission to bring innovation and unmatched quality to the managed care space. From the operating room to hospital administration: TPA , Carrier and Managed Care leadership: they understand the nature of your business and the pressures you face. That experience enables the team to think differently about solutions and provide smart, customized solutions.
WHAT WE LOOK FOR: IDEAL CANDIDATE IS A HIGHLY MOTIVATED AND DYNAMIC INDIVIDUAL THAT THRIVES IN A FAST-PACED ENVIRONMENT.
POSITION OVERVIEW:
TITLE: DATA ENTRY SPECIALIST - CASE INTAKE 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 INDEPENDENT MEDICAL REVIEW, AS WELL AS THE COORDINATION OF DAY TO DAY OFFICE ACTIVITIES. THIS POSITION IS RESPONSIBLE FOR RECEIVING INCOMING CASES AND DETERMINING ALL DETAILS FOR THE REQUESTED WORK PRODUCT. THIS IS A HIGHLY TEAM-ORIENTED POSITION. THE DATA ENTRY SPECIALIST - CASE INTAKE COORDINATOR 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 INTAKE WORK FLOW PROCESS FOR UTILIZATION REVIEW REFERRALS • RECEIVES AND COORDINATES ALL REFERRALS FOR PRIOR AUTHORIZATION, CONCURRENT REVIEW AND RETROSPECTIVE REVIEW WITHIN THE UTILIZATION REVIEW INDUSTRY • 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 UTILIZATION 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 • 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 WORK FLOW OF ALL REFERRALS • USES DISCRETION AND INDEPENDENT JUDGMENT IN ORGANIZING AND ASSIGNING TIME SENSITIVE DUE DATES TO ALL REFERRALS • RESPONSIBLE FOR DAILY CASE LOAD OF A MINIMUM OF 65 CASES DAILY • ABILITY TO WORK VIA WEB BASED PORTAL APPLICATIONS • 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 • GENERAL TYPING SKILLS AT 65WPM • DATA ENTRY 10 KEY SKILLS AT 5,000KPH / 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 • 1-3 YEARS DIRECTLY RELATED EXPERIENCE IN AN OFFICE BASED PROFESSIONAL SETTING
Company Description
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 collegial 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.