Andrew Klein

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 the status and PA review process.

· Organizes volume of work and workflow so that performance standards and proper procedures for PA review timelines according to client requirements and state and federal regulations are addressed.

· Documents activities in the database.

· Tracks the 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 the outcome of the 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 the physician advisor to conduct reviews and saves the information in the applicable case.

· Retrieves voicemail messages from physician advisors, forward information to care managers, and follow up with physician advisors for written reports to ensure receipt no later than 24 hours after the review is conducted.

· Contributes to department processes by attending department meetings, assisting in developing department goals and scorecards, and meeting individual performance standards.

• The Ergonomic Coordinator fulfills various aspects of system administration operations and customer support
• This includes the use of email, multiple online databases, ticketing systems and software solutions
• I work in direct contact with our Brio ergonomists and network providers to manage both virtual and onsite scheduling
• Scheduling appointments using online tools such as Outlook, Flex booker and Bookings calendar
• I develop and maintain lists for each client site by address and location
• Manage communication with various client contacts
• I provide support for both client and ergonomist.

• Manage the customer care procedures and manage client/customer relations
• Manage staff to ensure client care needs are met, staff are properly trained, monitor hours worked, evaluate client needs and fill shifts as needed, maintain appropriate staff bench levels for staffing and in-home assignments, support Payroll and Billing on a weekly basis, manage all personnel issues seeking guidance from HR as needed
• Assist the Director of Nursing with assessing staff performance to promote quality, continuity, and safety of a client's care
• Manage employee credentials using licensing database to ensure compliance with internal systems, processes and documentation and assure maintenance of clinical records in compliance with local, state and federal laws
• Supervise, educate and coach other field personnel, as directed by the Director of Nursing
• Provide information to be used for statistics, reports and records for purposes of evaluation and reporting of organization activities.

• Analyzed statistics to determine the level of customer service that organizations were providing
• Developed customer service procedures, policies and standards
• Provided superior customer service by telephone, email, letter and face to face
• Investigated and resolved customer issues including complex or long-standing issues that had not yet been resolved by other departments and resolved customer complaints ranging from customer dissatisfaction to major incidents.

• Investigated and resolved member complaints, member appeals, and provider disputes
• Provided resolution of grievance and appeal situations in compliance with legal and regulatory requirements
• Researched, investigated and resolved administrative member complaints and appeals for Medicare Part D and Medicare Private Fee for Service plans
• Assisted with CMS, NCQA and Health Plan audit preparation, documented complaints and appeals, prepared case files on clinical member appeals for medical director review and clinical complaint resolution letters
• Processed, researched, and resolved CMS issues as assigned and generated all case file acknowledgement and resolution letters and medical records requests.