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Case Review Specialist - Phone Intake & Documentation

OncoHealth
Remote, USA
Full-time
Mid · 2+ years experience
Remote
Discovered 1 months ago

Full Job Posting

  • Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 6 pm EST (Office hours may change/extend upon operational needs)
  • Inbound Call Management to include managing a high volume inbound call queue, averaging 60+ inbound calls per day, while maintaining quality, professionalism, and accuracy
  • Serve as the primary point of contact for inbound inquiries related to case status, case intake, documentation requirements, appeals, and next steps
  • Provide clear, accurate, and timely responses to providers and internal stakeholders, ensuring alignment with policies, procedures, and regulatory requirements
  • Accurately document all call interactions, actions taken, and outcomes within the case management system in real time.
  • Meet established call response and service level metrics, including: Maintaining an answering service level of 97% or higher Achieving an average speed of answer (ASA) of less than 30 seconds for at least 80% of answered calls
  • Maintaining an answering service level of 97% or higher
  • Achieving an average speed of answer (ASA) of less than 30 seconds for at least 80% of answered calls

• Case Intake & Case Management Support

  • Open, update, and maintain cases in accordance with established workflows and system requirements
  • Review incoming information for completeness and accuracy; identify missing or inconsistent data and initiate appropriate outreach or follow up
  • Coordinate with internal teams (Case Management, Customer Support, Medical Directors, Appeals, Claims, and Operations) to ensure cases move forward efficiently
  • Support appeal related activities by confirming documentation requirements, routing cases appropriately, and monitoring timelines.

• Quality, Compliance & Timeliness

  • Ensure all cases and call interactions meet quality, compliance, and audit standards
  • Adhere to turnaround time (TAT) requirements and service level agreements (SLAs)
  • Apply consistent judgment when escalating issues, identifying risks, or flagging potential delays
  • Maintain patient and provider centric communication at all times.

• Process Adherence & Continuous Improvement

  • Follow documented procedures and workflows while identifying opportunities for process improvement
  • Provide feedback on recurring call drivers, system gaps, or process inefficiencies.
  • Support the adoption of updated workflows, scripts, and tools as processes evolve
  • Demonstrate the ability to manage responsibilities independently with minimal oversight once trained.

• Collaboration & Professional Conduct

  • Partner effectively with cross functional teams to resolve issues and improve case outcomes
  • Maintain a professional, calm, and solution oriented approach, particularly in high volume or high pressure situations
  • Participate in team meetings, training sessions, and quality reviews as required
  • High school diploma or equivalent required
  • Associate or bachelor’s degree preferred, particularly in: Healthcare Administration, Health Information Management, Business, Administration or a related field. Relevant experience may be considered in lieu of a degree
  • Typical years of experience are minimum of 2 years in healthcare operations, utilization management, case management, intake, call center, or a related operational role
  • Strong verbal and written communication skills
  • Ability to manage high call volumes while multitasking across systems
  • High attention to detail with strong documentation practices
  • Ability to work independently while following structured processes
  • Strong problem solving skills and sound judgment
  • Proficiency with case management systems and standard office technology
  • Systems/Tools: MS Office Suite proficient

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