QTC Management Medical Case Specialist I (VA Services) in Diamond Bar, California

Requisition Number16-1640

Post Date12/1/2016

TitleMedical Case Specialist I (VA Services)

FLSA StatusNon-Exempt

PT/FTFull Time = 40 Hours

CityDiamond Bar

StateCA

Description

Job Summary:

Under close 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:

  • Responsible for satisfactory completion of training program for Case Specialist Trainee

  • Answer phones from automated call distribution system

  • Triage daily download of referrals and ensure appropriate worksheets are assigned to corresponding conditions as identified by Veteran’s 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

Requirements

Competencies:

  • Proven ability to plan and organize work load

  • Ability to manage competing priorities in a fast paced work environment

  • Good follow through skills

  • Work well in a team oriented work environment

  • Strong verbal and written communication skills

  • Excellent customer service skills with ability to critically evaluate and resolve problems

  • Must possess the ability and flexibility to work early morning, evening, and/or weekend shifts

Education and/or Experience: (includes certificate & licenses)

  • High School diploma or equivalent experience/combined education.

  • 0 to 1 year of experience in healthcare, medical, or insurance related industries

  • Vocational training in specific aspects of job functions and/or demonstrated ability to perform assigned tasks, preferably in a medical related area of study (i.e. LVN, LPN, EMT, MA, Military Medic, etc.).

  • Experience with electronic medical scheduling and case management software

  • Experience with medical coding and knowledge of medical terminology

  • Strong computer skills at intermediate level

Physical and Mental Requirements:

The physical and mental requirements and abilities described herein represent those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities

to perform the essential functions.

Specific mental requirements and abilities essential to the performance of this position include but are not intended to be all-inclusive: reading comprehension and writing capabilities, adaptability, analyzing, assessing, calculating, decision-making, good

judgment, social skills, ability to follow instructions, and self-management.

Specific physical requirements and abilities essential to the performance of this position include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. While performing the duties of this job, the employee is regularly

required to stand; sit; use hands to finger, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arm. The employee is occasionally required to walk and stop, kneel, crouch, crawl, or lift and/or move up to 20 pounds.

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.

  • All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans.