Job description

**This is a Program Coordinator for our Independent Review Organization, and this position coordinates receiving and sending medical cases for. physician review.

Job Summary:

Responsible for receiving medical claims cases from external and internal client and coordinating the case flow to and from AMCM’s physician reviewer panel.

The IRO Coordinator’s primary responsibility is to manage and coordinate client’s Independent Review Organization (IRO) medical claims case reviews and coordinate the process across AMCM’s physician reviewers. The IRO Coordinator will interact on a daily basis with the physician reviewers, clients, Medical Directors, healthcare consumers and providers as needed to effectively resolve internal and external review cases. The IRO Coordinator will also validate incoming correspondence determined the physician review needed and initiate appropriate procedures.

Essential Duties and Responsibilities:

· Receives cases from internal and external customers via the AMCM IRO Portal.

· Reviews referrals for clarity and completeness.

· Determines if the medical claims case needs to have a state-match and which specialty (physician board certification) match is required.

· Arranges a review by an AMCM physician reviewer, often working in conjunction with the Physician Review Medical Director or Corporate Medical Director.

· Tracks cases in the AMCM database to comply with turnaround time requirements.

· Reviews the physician reports for completeness and accuracy.

· Provides reports to the clients, consumers (members), and other entities as appropriate.

· Works with physician reviewers to set the on-call schedule.

· Tracks internal physician reviewer schedules and provides to internal staff.

· Verifies physician reviewer time billing for accuracy.

· Handles inquiries from customers concerning case review status and activities.

· Track inquiries from physicians interested in contracting with AMCM as a physician reviewer; coordinates and fully completes the application packet process for physicians that are determined appropriate to contract with AMCM.

· Regularly reviews physician credentials, including all state licensure, board certifications and other credentials, in the AMCM credentialing system to ensure that all licensure is current, up-to-date and in good standing in accordance with state law and URAC accreditation.

· Works with the leadership team to prepare for, and participate in, AMCM successfully preparing for and passing URAC accreditation and other audits.

Education and/or Experience:

(i.e., Master’s, Bachelor’s or Associate’s degree, High School Diploma and/or Certifications, and number of years and type of relevant experience required)

· High school diploma

· College degree preferred but not required

Knowledge and skills: (i.e., verbal and written communication skills, analytical skills, organization skills, computer knowledge, sales knowledge, etc.)

· Excellent oral and written communication skills

· Ability to work independently as a team member

· Interpersonal and organizational skills

· Computer competency

· Knowledge of Microsoft Office and Excel

· Excellent record keeping ability

· Knowledge or understanding of healthcare case or claims reviews, medical coding or previous medical background required.

Physical Demands: (i.e., if applicable, lifting boxes or equipment, indicate maximum weight, electrical wiring, painting, etc.)

· Lifting up to 25lbs. on occasion

Work Environment: (i.e., office, mailroom, construction (cable wiring, telecomm), etc.)

· Office

Job Type: Part-time

Schedule:

• Day shift
• Monday to Friday

Experience:

• health-related: 1 year (Required)
• program coordination: 1 year (Required)

Work Location: Hybrid remote in Salem, NH 03079

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