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Physician Scheduling Coordinator
Ref No.: 18-15523
Location: San Diego, California
Schedules Physician Advisor (PA) and Medical Director clinical reviews for care management centers. Performs follow-up to ensure reviews occur as scheduled and verbal and written reports are generated by Physician Advisors. Analyzes pending completion rate based on PA review due dates. Provides updates to relevant departments to ensure turnaround time compliance with accreditation and regulatory organizations. Documents all steps in the process plus Physician Advisor decision/outcomes into respective systems.
Schedules Physician Advisor and Medical Director clinical peer to peer reviews.
Receives requests from various departments to schedule physician advisor reviews.
Consults with managers on problem cases and interfaces with case managers, clinical supervisors, account managers and other staff in resolving PA review and scheduling issues.
Provides overall analysis of PA review cases completion rates
Responds to member, provider, and client telephone inquiries regarding status and PA review process.
Organizes volume of work and work-flow so that performance standards and proper procedures for PA reviews timelines according to client requirements and state and federal regulations are addressed.
Documents activities in database.
Tracks number of reviews performed on a daily basis by account, type of review, physician advisor, outcomes and care manager.
Documents physician scheduling process in respective systems, as well as outcome of review.
Contacts physician advisors to determine availability and timing to perform reviews as well as coordinates with facilities and providers to determine availability and timing for doctor to doctor discussions.
Forwards all appropriate clinical information, criteria and forms to physician advisor to conduct reviews and saves the information in the applicable case.
Retrieves voicemail messages from physician advisors, forwarding information on to care managers and follows up with physician advisors for written reports to ensure receipt no later than 24 hours after review conducted.
Contributes to department processes by attending department meetings, assisting in developing department goals and scorecards and meeting individual performance standards.

Requirements/Certifications:- (1) Opening

- Potential conversion to FTE
- In office position; NOT remote
- 8:30 - 5:00 PM shift
- Computer skills key; comfortable toggling between different computer applications and softwares
- Experience working with timelines is strongly preferred; even more so in a healthcare setting
- Resources will be fielding calls from customers and providers; phone skills important
The role is within the appeals department, but focuses on Scheduling Peer Reviews for our in house doctors. Applicants need to be comfortable using outlook, scheduling appointments, making and receiving calls, have great attention to detail, and would prefer someone with experience in healthcare environment. The same type of candidates that have been submitted for appeals coordinators would be perfect.