Job description

Job Summary:

This position will accept referrals either manually or systematically to review, collect and submit information to health plans to expedite approval for care. This information will take the form of either a notification that the patient has been admitted to the Medication Assisted Treatment program or a submission of clinical information either directly or indirectly. This position will work closely with the Revenue Cycle Case Manager to gather appropriate information as per the patient's health plan.

Essential Functions:

• Receives incoming manual requests to process a notification of admission to a Medication Assisted Treatment program and/or gather appropriate clinical information to submit to the patient's health plan, either directly or indirectly.
• Utilizes system-generated reports to process a notification of admission to a Medication Assisted Treatment program and/or gathers appropriate clinical information to submit to the patient's health plan, either directly or indirectly.
• Communicates to local clinical program the need for a particular element of clinical information if none exists and capture the date of that request for later systematic management.
• Provides clinical information to health plans upon receipt of the appropriate information and capture the date of that submission for later systematic management.
• Monitors and responds to a systemic listing of clinical documentation submitted where no response or authorization number from the health plan has been received.
• Provides a systemic listing of clinical documentation requests that are greater than five calendar days from the date of the request and coordinate that listing with the Case Manager.
• Other duties as assigned.

Supervisory Responsibilities:

(Scope of the person's authority, including a list of jobs that report to this job).

N/A

Essential Qualifications:

(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the competencies (minimum knowledge, skill, and ability) required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).

Education/Licensure/Certification:

The position will require a high school diploma or GED.

Required Knowledge:

The ideal candidate will have a familiarity with medical records and common healthcare terms and processes so that there is a basic understanding of the purpose in submitting clinical information in order for a health plan to approve a regiment of care.

Experience Required:

The ideal candidate will have a minimum of three years' experience in healthcare roles where they have been associated with a level of medical records and common healthcare terms in order to have a clear understanding of the position.

Skill and Ability:

The approach outlined to procure either a notification of admission to a Medication Assisted Treatment program or submission of clinical information for authorization is a highly-mechanized process that is both predictable and defined. It is critical that the individual who serves in this role follow protocol and communication exceptions, errors or work performed out of sequence to Management.

Physical Demands/Work Environment:

(The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

Finger Dexterity:

Use primarily for writing, operating calculator, telephone, keyboard and other office equipment.

Talking:

To convey detailed or important instructions to employees, patients and applicants.

Hearing:

Ability to hear normal conversations and receive ordinary information.

Vision:

Average, ordinary, visual acuity necessary to observe patients and work on computer. Clear vision at 20 inches or less and distant vision at 20 feet or more.

Physical Strength:

Sedentary work; sitting most of the time. Exerts up to 10 pounds of force occasionally.

Working Conditions:

(The working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

➢ Ability to operate in an open work area with moderate everyday noise.

➢ Ability to travel occasionally for educational and workshop opportunities.

➢ Ability to perform other duties as required.

Core Competencies:

➢ Analytical Skills

➢ Business Acumen/Understanding the Organization

➢ Communication

➢ Detail Orientation/Attention to Detail

➢ Ethics/Values/Integrity

➢ Information Gathering

➢ Problem Solving

➢ Time Management

Mental Activities:

(The mental activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

Reasoning Ability:

Ability to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

Ability to maintain confidentiality.

Mathematics Ability:

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumferences and volume.

Language Ability:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and governmental regulations. Ability to write reports and business correspondence. Ability to effectively present information and responds to questions from groups of managers, employees, patients and the general public

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Hybrid remote in Maitland, FL 32751

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