Medical Assistant - Case Review Specialist - San Franscisco

Medical Assistant - Case Review Specialist

We are seeking a Medical Assistant – Case Review Specialist to support our Federal Occupational Health (FOH) contract in San Francisco, CA. The role is remote with occasional on‑site visits required.

Provides direct support to the mission of FOH, a component of the Program Support Center (PSC), by performing case review activities, interacting with customers, and coordinating service delivery with the FOH Business Operations team.

• Ensure exam scheduling requests are submitted timely and notifications are tracked in accordance with designated time frames.
• Retrieve exams for case review processing from FOH clinics and the FOH Private Provider Network clinics.
• Enter tickets for services performed at FOH Private Provider Network (PPN) clinics.
• Process exams, complete QA, track missing components, ensure completeness per the work order, and send the exam to the RMO for processing.
• Track exams and ensure exam processing is fluid and timely.
• Enter applicable data on RMO Timesheets.
• Ensure medical reviews, letters, and exams are sent securely as applicable.
• Enter tickets to charge the associated agency for the AMA/RMO time.
• Participate in cost recovery efforts, including verifying, validating, editing, and updating billing tickets as needed.
• Professionally communicate with team members and internal/external customers.

• Ensure case review processing time frames and QA parameters are met as directed by the Program Manager.
• Attend all mandatory meetings and training as assigned.
• Demonstrate understanding of the Case Review process and learn new workflows.
• Display competencies in all areas of case review.

• Ensure scheduling requests are submitted within 24 hours of receipt to the appropriate OHC or through the PPN.
• Retrieve medical records using the PPN portal daily and internal electronic file storage.
• Reach out to OHC clinic to request records after exam completion and follow up on missing items timely.
• Ensure exams are processed timely to meet FOH requirements; QA, send to RMO, complete data entry, and send RMO determination to agency.
• Escalate missing exam items to PM when items are not received.
• Transmit exams according to IAA specifics and track dates.
• Report all privacy and security breaches immediately per FOH and HHS policy.
• Attend meetings with team and internal customers as directed.

• Coordinate with Business Operations to provide customer services through FOH OHCs and the PPN.
• Assist with implementing new case review business and changes when agreements are initiated or modified.

• Ensure RMO and administrative billing is completed, review discrepancies, and notify PM.
• Review PPN invoices monthly, identify discrepancies, and correct billing as needed.
• Ensure all billing items are entered correctly and timely.
• Demonstrate a complete understanding of the billing database, RMO reviews, and exam tracking.
• Participate in rolling audits by analyzing reports and validating charges.

• Be on time to work and work all designated hours as determined by PM.
• Request leave according to specified time frames with vendor and PM.
• Adhere to telework policy when permitted.
• Create a climate of trust, accountability, and professionalism; report staffing concerns to PM.
• Identify and report problems with hardware, telecommunications, or other issues impacting duties to PM.

• Be fully knowledgeable and proficient in IT systems for database tracking, billing, and other deliverables (Microsoft Word, Excel, Outlook, Teams, Adobe Acrobat).
• Attend training on IT systems and complete mandatory training by specified deadlines.
• Inform PM of IT or equipment needs that prevent completion of case review processing within deadlines.
• Perform all FOH tasks on Government Furnished Equipment.

• Manage customer/agency complaints professionally, providing feedback within 24‑48 hours.
• Ensure exam processing timeline is met per the agency agreement.
• Communicate with RMOs regarding specific/urgent requests.

• Generate customer specific reports as required per the agency agreement.
• Input data into…