Case Coordinator (31828)

Are you a detail‑driven professional with a passion for quality and compliance?

Join us as a Case Coordinator, where you will play a critical role in ensuring medical reports meet the highest standards of accuracy, integrity, and regulatory compliance. The Case Coordinator is responsible for ensuring reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is required to assist with quality assurance questions and provide overall support to the Quality Assurance Department.

The location will be determined by the client’s place of residence:

• 4141 Southwest Freeway, Suite 500, Houston, TX 77027
• 12001 N Central Expressway, Suite 800, Dallas, TX 75243

Hours: 8:30 am - 5:00 pm CST

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Ensures the provider credentials and signature are adhered to the final report.
• Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Ensures all federal ERISA and/or state mandates are adhered to at all times.
• Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promotes effective and efficient utilization of company resources.
• Participates in various educational and or training activities as required.
• Performs other duties as assigned.
   

EDUCATION AND/OR EXPERIENCE 

• High school diploma or equivalent required.
• Minimum of two (2) years of clinical or related field experience, or an equivalent combination of education and experience.
• Knowledge of the insurance industry preferred, particularly claims management related to:
  • Workers’ compensation
  • No‑fault
  • Liability
  • Disability

CERTIFICATES, LICENSES, AND REGISTRATIONS 

No specific requirements.

ESSENTIAL COMPETENCIES & QUALIFICATIONS

• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
• Must be a qualified typist with a minimum of 40 W.P.M
• Must be able to operate a general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Ability to accurately follow instructions and respond to directions from upper management.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team-oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Demonstrates reliability and abides by the company attendance policy.
• Must maintain a professional and clean appearance at all times consistent with company standards.

• Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements and legal contracts and documents.
• Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
• Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.

• Sitting 8 hours per day
• Walking and standing for brief periods
• Occasionally climbing one or more flight of stairs
• Occasionally lifting and/or carrying up to 10 lbs.
• Occasionally pushing/pulling up to 10 lbs.
• Occasionally subject to bending, squatting or twisting.
   

WORK ENVIRONMENT

• Extended hours are occasionally required beyond the regular eight (8) hour work day.
• The noise level in the work environment is usually moderate.