Case Review Specialist/Medical Assistant

STGi is currently seeking a Case Review Specialist/Medical Assistant to support our Federal Occupational Health (FOH) contract in Rockville, MD. This is an onsite-hybrid position; telework schedule follows after a probationary period.

About the Role

Provides direct support to the mission of Federal Occupational Health (FOH), a component of the Program Support Center (PSC), to improve the health, safety, and productivity of the Federal workforce. The role involves performing case review activities, interacting with internal and external customers, coordinating service delivery with the FOH Business Operations team, and ensuring exam scheduling, medical record management, Quality Assurance (QA) checks, and billing are completed according to the Interagency Agreement (IAA).

Responsibilities

• Ensure exam scheduling requests are submitted timely and appointment notifications are tracked in accordance with designated timeframes.
• Retrieve exams for case review processing from FOH clinics and the FOH Private Provider Network (PPN) clinics.
• Enter tickets for services performed at PPN clinics.
• Process exams, including QA checks, tracking missing components, and ensuring exams are complete per the work order before sending to the Reviewing Medical Officer (RMO).
• Track exams to ensure timely processing and fluid workflow.
• Enter applicable data on RMO timesheets and ensure secure transmission of medical reviews, letters, and exams.
• Enter tickets to charge the associated agency for AMA/RMO time and participate in cost recovery efforts, including verifying, validating, editing, and updating billing tickets.
• Communicate professionally with team members, internal and external customers, and clinics to retrieve missing exam items.
• Ensure scheduling requests are submitted within 24 hours of receipt to the appropriate Occupational Health Clinic (OHC) or PPN.
• Retrieve medical records daily using the PPN portal and internal electronic file storage, and follow up on missing exam items.
• Escalate missing exam items to the Program Manager (PM) when necessary and report privacy/security breaches immediately.
• Coordinate with the Business Operations team to provide customer services and assist with implementing new or modified case review requirements.
• Review PPN invoices monthly, identify discrepancies, and ensure billing is completed accurately and timely.
• Participate in rolling audits by analyzing reports, validating charges, and rectifying discrepancies.
• Manage customer/agency complaints professionally, providing feedback within 24-48 hours or escalating to the PM as needed.
• Generate customer-specific reports and input data into tracking sheets for metrics as requested by leadership.
• Suggest process improvements to ensure quality and efficiency goals are met.
• Adhere to telework policies, report staffing concerns, and identify/report hardware or IT issues impacting duties.
• Attend mandatory meetings, training, and maintain proficiency in IT systems (e.g., Microsoft Word, Excel, Outlook, Teams, Adobe Acrobat).

Requirements

• Medical Assistant Degree/Certification required, including passing a national certification exam such as the Certified Clinical Medical Assistant (CCMA) or Certified Medical Assistant (CMA).
• Bachelor’s Degree in Business or a health-related field preferred, or a minimum of 2 years’ experience performing administrative duties in a healthcare program.

Skills

• Highly organized with the ability to manage competing priorities and work efficiently in a fast-paced production environment.
• Excellent oral and written communication skills, with the ability to escalate problems or resource issues appropriately.
• Strong interpersonal communication skills and the ability to develop/maintain effective procedures for team communication.
• Proficient in MS Excel, Word, Teams, and Outlook; typing speed of 40 wpm.
• Fully knowledgeable and proficient in IT systems for database tracking, billing, and other deliverables.

Benefits

• Competitive benefits package including Medical, Dental, and Vision coverage.
• 401k with company match.
• Generous PTO policy.

Pay

Starting at $22/hour.