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Summary:

• The MEC is responsible for coordinating IME/IPE/FCE/MCE services ("EVAL Services") from case intake to final report submission including scheduling.

Role and Responsibilities:

• Process and manage all referrals received for evaluation services.
• Ensure the most appropriate selection of the evaluation provider available to handle an assigned case. Pertinent selection criteria when selecting an evaluation provider shall include, but not be limited to, the service type being requested, evaluation provider specialist, evaluation cost and terms, quality, and compliance history, etc.
• When selecting evaluation providers, the MEC shall verify the current credentials of the evaluation provider. Verification of credentials shall include, but not be limited to, confirming primary source verification for state licensure and board certification (where applicable).
• During the selection and scheduling of the evaluation with the evaluation provider, the MEC shall analyze for potential conflicts of interest and, as applicable, report them to the team leader before proceeding with the evaluation.
• Upon selection of the appropriate evaluation provider, the MEC shall schedule the appointment and provide all required documentation to the evaluation provider's office, the referring party, and the claimant, and provide copies to the appropriate parties (e.g., legal counsel, etc.).
• Timely track receipt of medical records for a scheduled evaluation. As applicable, follow up with the referring party if medical records are not timely received. Upon receipt of the complete medical record set, prepare medical records and deliver them to the evaluation provider.
• Maintain communication with the referring party in all key aspects of evaluation scheduling and coordination. The MEC shall further communicate with the referring party regarding any changes to the evaluation, including but not limited to proposed changes in specialty, appointment date/time change, provider change, etc.
• Perform telephonic outreach to claimants throughout the evaluation process, including but not limited to informing claimants of scheduled appointments, answering questions regarding the evaluation, confirming evaluation appointments, and providing aid as requested.
• Timely communicate to the referring party the outcome of an evaluation appointment (i.e., show or no-show status).
• Perform timely and routine follow-up with the evaluation provider for outstanding evaluation reports. Notify the team leader of any evaluation reports that are delayed and work to ensure timely delivery.
• Assist the Quality Nurse Reviewer in working with the evaluation provider on outstanding quality issues and follow-up, as required.
• Initiate evaluation addendum/supplemental addendum requests, as applicable.
• Document applicable evaluation activity in the claims management system to ensure complete and accurate case records, including but not limited to case notes, emails, case reminders, and tasks.
• Search for, and recruit, new evaluation providers as needed. Deliver to new evaluation providers all required information, including information regarding credentialing, service agreement, price level agreement, and other applicable information.
• Credential newly recruited evaluation providers in accordance with corporate policy and procedure and ensure that all required credentialing documentation is stored appropriately.
• Perform general administrative duties related to evaluation services, including but not limited to copying, scanning, faxing, and/or mailing.
• Other duties as assigned.

Required Qualifications and Education:

• High School Diploma or GED
• Working knowledge of computer operation and software applications, including Microsoft Office
• Ability to work independently
• Knowledge of medical terminology
• Excellent verbal and written communication skills
• Excellent customer service skills
• Experience in applying general office policies and procedures and handling confidential information
• Ability to work well under pressure and to meet multiple and sometimes competing deadlines

ADA Requirements:

Physical/Mental Demands:

Normal office environment. Stressful conditions may arise when the workload becomes more demanding than normal. The physical requirements of the job are considered Sedentary Work per the U.S. Department of Labor, which is work involving the exertion of up to 10 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary Work involves sitting most of the time but may involve walking or standing for brief periods of time.

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