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Medical Coordinator

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Best Doctors Insurance, When You Need Us, We'll Be There. Since 1989, BDI has been a leading international private health insurance company in Latin America, the Caribbean, and Canada, dedicated to connecting members with the best possible healthcare worldwide. Our mission is to empower individuals and families to access top-tier medical specialists and treatments, ensuring the highest quality care when they need it most.

At Best Doctors Insurance, we provide our members with the very best healthcare by delivering unique health plans of the highest quality. For over 30 years, our insurance products have been the premier staple in the industry, and the standards we set, along with a wide range of exclusive benefits, are the key differentiator in the lives of our members.

The Medical Coordinator is responsible for reviewing requests related to the evaluation and authorization of medical services. This role requires the ability to work independently, exercise sound judgment, and interact directly with our clients. The ideal candidate will have an understanding of healthcare systems, terminology and administrative process. A commitment to delivering exceptional client service is essential. The Medical Coordinator will operate under the supervision and guidance of the Medical Administrative Supervisor, contributing to the overall efficiency and quality of the medical review process

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

  • Works independently to request and review medical information necessary for the authorization of health services. Adheres to established guidelines, procedures and standards when reviewing medical cases, utilizing resources such as ICD/CPT coding guidelines, Encoder and Physician's Fee/coding guide)
  • Provides benefit information via phone, email and Live Chat and requests medical documentation as needed
  • Handles emails received through the Precert inbox, ensuring that emails are answered professionally and within the established 48–72-hour time frame.
  • Evaluate medical fees for cost control while following the Usual Customary and Reasonable (UCR) fee schedule and steering guidelines. Negotiate with providers and doctors if fees exceed UCR for the services described.
  • Delivers exceptional service and maintains phone call service level within established guidelines
  • Demonstrates the ability to work effectively both independently and collaboratively within a team environment.
  • Exercises sound judgment in decision-making when handling complex situations
  • Maintains strong attention to detail and effectively manages multiple tasks in a fast-paced environment
  • Participates in the after-hours on-call schedule as needed to ensure continuous coverage
  • Proactively follows up on pending cases and issues authorization/denials in accordance with established guidelines

DESIRED MINIMUM QUALIFICATIONS:

  • The ideal candidate will demonstrate a strong passion for service excellence, with a prompt, courteous and customer-focused attitude
  • Able to communicate clearly and effectively in both English and Spanish, verbally and in writing
  • Adapts well to change and maintains a positive, professional demeanor in dynamic environments
  • Remains composed and effective under pressure, with the ability to manage stressful situations
  • Detail-oriented and self-motivated with excellent follow up and organizational skills
  • Capable of balancing workloads and prioritizing tasks to efficiently meet deadlines
  • Works well independently and collaboratively as part of a team
  • Exercises sound judgment and discretion when making decision that may have financial implications
  • Proficient with MS Office Suite (Outlook, Excel, Word) and familiar with web-based applications
  • Comfortable handling a high volume of calls/emails while maintaining service quality
  • Strong organizational and time management skills
  • Knowledge of medical terminology and familiarity with ICD/CPT coding is a plus

EDUCATION AND EXPERIENCE:

  • Minimum of one (1) year of experience in an administrative or customer service role in fast-paced environment
  • College education required
  • One (1) year of experience in a medical administrative setting is a plus-this--may include roles in insurance companies, hospitals, physician offices or similar healthcare environments
  • On-the-job training opportunities may be available depending on previous experience and demonstrated competencies