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Case Administrator Coordinator

Spectraforce Technologies
United States, South Carolina, Columbia
Mar 13, 2025
Role Name: Case Administrator Coordinator Location: Columbia, SC 29229 Work Environment: Remote (After Onsite training) Schedule: Mon to Fri, 6 am - 2:30pm OR 8:30 am - 5pm Contract length: 3 months assignment with possible conversion Job Summary: Duties/About the role: Responsible for supporting and maintaining the coordination of daily operations of assigned area. Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function. Day to Day: 60% Maintains the outpatient authorization process to include ensuring benefit coverage, reviewing/determining eligibility, reviewing of established utilization review criteria, interpreting rules/regulations. Completes authorization by following established policies/procedures. 20% Reviews interdepartmental requests and medical information to complete utilization process. 15% Documents process used and decision in the appropriate system in accurate/timely manner. 5% Establishes/maintains effective business relationships with primary care physician offices, other providers of health services. Team Info: My team is a mix of RNs and LPNs, that review denied claims for all service types in healthcare. Any extra/additional job info: NA Job Requirements: Required Experience: 3 years managed care in healthcare, physician's office, or insurance company setting. Required EDU: Other Degree - Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. Required Certification or licenses: Active, unrestricted LPN/LVN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC). Required Software and Tools (Hands on experience required): Microsoft Office Soft skills: communication skills Nice to have/Preferred skills: Any background with filing or reviewing appeals, post- service experience highly preferred. Background with billing and coding or claims review. Broad clinical background