Medical Review Coordinator

Title: Medical Review Coordinator Department: Pension
Union: UFCW 1546 Multi Grade: 23

Position Summary

The Medical Review coordinator ensures documentation needed for medical review is complete and accurate in accordance with Company policies, regulatory requirements, and plan guidelines.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities


* Maintains current knowledge of assigned Plan(s).


* Assembles documentation needed to substantiate retirement benefits claims.
+ Reviews documentation submitted to ensure accuracy and completeness.
+ Coordinates with processors to obtain missing or incomplete documentation.
+ Forwards completed documentation to third party vendor for medial review.


* Acts as clinical resource to the department.


* Conducts special reviews as needed by the client.


* Performs other duties as assigned.

Minimum Qualifications


* High school diploma or GED


* One year of experience working in healthcare.


* Knowledge of medical terminology CPT, ICD-10 diagnosis codes.


* Understanding of confidentiality in dealing with sensitive and personal information.


* Excellent organizational skills with an attention to detail.


* Excellent communication skills; comfortable interacting with all levels of an organization and its external partners.


* Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.


* Proficiency with MS Office tools and applications

Preferred Qualifications


* Familiarity with third party administrators and Taft-Hartley retirement funds preferred.


* Experience with retirement plan disability provisions.


* Current ARNP or LPN license



*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job.

Duties, responsibilities and activities may change at any time with or without notice.

Working Conditions/Physical Effort


* Prolonged periods of sitting at a desk and working on a computer.


* Must be able to lift up to 15 pounds at times.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship.

The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process.

If reasonable accommodation is needed, please contact the Recruiting Department at recruiting@zenith-american.com , and we would be happy to assist you.

Please note that in compliance with certain state law, we a...