Job Description

Job Title: Medical Coordinator – Trilingual (Customer Service Representative)

Pay Range - $23 - $24/hr.

Location –Miami, Florida 33126

Contract of 6 Contract to hire.

Responsibilities:

• The Precert department works off a rotation schedule in order to have 24-hour coverage of the phones and emails. Part of this coverage also includes the rotating on call shift, as needed, which requires mandatory participation. Coordinators are required to be part of these schedules and must be available to work his/her assigned shift.

• 8AM – 4PM
• 10AM – 6PM
• Afterhours backup coverage based on rotation schedule
• Weekends and/or holidays on call shift based on rotation schedule

JOB DESCRIPTION:

The Medical Coordinator reviews requests for the evaluation and authorization of medical services mainly in Brazil. The ideal candidate will be able to work independently and make judgement calls. He/she will have direct interaction with members, agents or providers and will need to become knowledgeable of policy benefits; ICD/CPT codes in order to properly evaluate cases and answer questions. The desire of providing excellent client service is a fundamental requirement of this position. The person will work under the supervision and guidance of the Medical Admin Supervisor

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

• Acts autonomously and requests medical information for the authorization of medical services. Follows existing guidelines’ procedures and standards when reviewing medical cases (ICD-10, Encoder and Physician’s Fee/coding guide),
• Provides explanations of benefits via phone, email and Live Chat. Gives policy benefits when required and requests necessary documentation for the evaluation of services.
• Monitor emails received in Precert inbox, ensuring that emails are answered professionally and within the established 24-48-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.
• Provides exceptional service while ensuring that emails are answered within 24-48 hours, service level is maintained above 90% and authorizations are issued without errors.
• Ability to work independently or as part of a team. Able to make judgement calls
• Attention to detail and ability to multi task
• Work the after-hours on call schedule as required
• Follows up on pending cases. Issues authorizations or denials as required
• DESIRED MINIMUM QUALIFICATIONS:
• The ideal candidate will demonstrate a passion for being service oriented, prompt and courteous; have a positive, customer-focused attitude and demonstrated adaptability to changes
• Ability to express verbally and in writing clearly and succinctly in English and Spanish
• Able to cope with stressing situations
• Special attention to detail and self-motivation
• Excellent follow-up and organizational capabilities
• Ability to maintain a balanced workload and prioritize accordingly
• Ability to work well individually and with others as part of a team
• Must exercise consistent judgment and discretion as his decisions by approving cases may impact the company financially
• Proficient with computers, MS Office (Email, Excel, Word) and office equipment (fax, copier, phone).
• Ability to handle high volume of calls/emails
• Excellent Organizational skills
• Medical terminology knowledge is a plus
• Required proficiency in English, Spanish and Portuguese

EDUCATION AND EXPERIENCE:

• A minimum of one (1) year of experience working in an administrative position or providing customer service in fast-paced entrepreneurial company
• College education required
• One (1) year of experience working in a medical administrative position in the U.S. medical system is a plus (experience could be from having worked in an insurance company, as office manager or similar position in a hospital or physician’s office).
• Opportunity for on the job training may be available based on previous experience

Dexian is a leading provider of staffing, IT, and workforce solutions with over 12,000 employees and 70 locations worldwide. As one of the largest IT staffing companies and the 2nd largest minority-owned staffing company in the U.S., Dexian was formed in 2023 through the merger of DISYS and Signature Consultants. Combining the best elements of its core companies, Dexian's platform connects talent, technology, and organizations to produce game-changing results that help everyone achieve their ambitions and goals.

Dexian's brands include Dexian DISYS, Dexian Signature Consultants, Dexian Government Solutions, Dexian Talent Development and Dexian IT Solutions. Visit to learn more.

Dexian is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.

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