Benefits Determination Unit Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide administrative and operational support for the Benefits Determination Unit.

• Coordinate peer-to-peer reviews, physician evaluations, and consultations with the Medical Director.

• Oversee scheduling, tracking, reviewer availability, credentials, and pertinent records.

• Assist in benefit determination activities, which include review coordination, documentation, communication, escalations, reporting, meeting support, and case assignments.

• Monitor time-sensitive review activities and facilitate adverse benefit determinations, expedited appeals, retrospective reviews, and related utilization management workflows.

• Aid in meeting regulatory, accreditation, contractual, and organizational compliance standards.

• Ensure accurate documentation and safeguard confidential information.

• Support audit processes and reporting activities.

• Report any workflow or compliance risks.

• Participate in process improvement initiatives and ensure timely and efficient workflow management.

⛳️ Requirements

• A bachelor’s degree with two years of relevant experience in healthcare, managed care, or customer service settings, or a high school diploma (or equivalent) with five years of relevant experience in such environments.

• An equivalent combination of education and experience will be taken into account.

• Strong organizational, written, and verbal communication skills.

• Professional demeanor with the ability to collaborate effectively with various professionals and staff at all levels, both internally and externally.

• Highly motivated, detail-oriented, and capable of taking initiative while working independently as well as part of a team.

• Excellent interactive and interpersonal skills.

• Advanced proficiency in MS Office Suite, including the ability to document information while taking calls.

• Competence in identifying issues, adhering to established processes, escalating concerns appropriately, and ensuring timely completion of assigned tasks.

• Flexibility in managing multiple priorities and meeting deadlines.

• Ability to maintain confidentiality and handle sensitive healthcare information responsibly.

• Must pass a background check upon hiring and throughout employment, which includes checks for criminal history, identity, education, employment, sanctions, prohibited parties, and drug screening.

• Access to high-speed internet with a minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds, installed prior to starting.

• A quiet workspace with minimal background noise for calls.

• Capacity to remain stationary and seated for extended periods, communicate and exchange information, inspect documents, perform repetitive motions, interpret data, solve problems, make decisions, organize and plan, and maintain a positive and professional demeanor.

🏝️ Benefits

• Annual performance-based discretionary incentive.

• Medical, dental, and vision insurance coverage.

• 401(k) plan with a competitive employer match.

• Company-paid life and disability insurance.

• Paid parental leave and wellbeing incentives.

• Generous paid time off, including time for volunteering.

• Flexible spending accounts for healthcare and dependent care.

• Opportunities for professional development and tuition reimbursement.

• Remote work options (dependent on the role).

• Company-provided equipment.

• Opportunities for meaningful personal and professional growth.