Department: Health and Human Services (IMCare Division)
Classification: Grade 7 (Local 580)
FLSA Status: Non-exempt
Position Description: The primary point of contact for members, hospitals, doctors, pharmacist and health providers; respond to inquiries and request for information about coverage questions.Responsible for entering service authorizations/ referrals into Casetrakker. Administrative support to the IMCare Director, Associate Director, Medical Director, Disease Management, QI/UM nurses and Care Coordinators. Prepare letters, committee minutes, and coordinating meetings. Maintain filing system. Lead for the monthly member education sessions. Assist in reviewing pending claims on the A-Z list.
Current Vacancy: One (1) Regular, F/T position
Open Competitive Job Opportunity : Open to applicants of the public.
1. Member Services:
a. Receive calls from IMCare enrollees and providers.
b. Set up referral and Prior Authorization (PA) requests in the data system.
c. Collect information and prepare referral and PA requests for review by QI/UM Nurses and Medical Director.
d. Record initial enrollee complaints and concerns, problem-solve, and educate enrollees as indicated.
e. Assist QI/UM Nurses in enrollee complaint resolution, reporting, and tracking.
2. Administrative support to IMCare Director, Associate Director, Medical Director, Disease Management Coordinator and QI/UM Nurses:
a. Prepare letters, committee minutes, and other dictation for the Director, Associate Director, Medical Director, Disease Management Coordinator and QI/UM Nurses.
3. QI/UM support to QI/UM Nurses and IMCare Staff:
a. Assist with drafting and maintenance of QI/UM policies and procedures, enrollee and provider education materials and other program materials.
b. Maintain QI/UM tracking systems, compile statistical data, and assist in preparation of reports.
c. Assist in reviewing pending claims and resolution of referral and PA problems.
d. Assist QI/UM nurses and IMCare staff in reviewing paid claims data for utilization monitoring by enrollees and/or providers.
4. Office Procedures:
a. Maintain the filing system for referrals, PA requests, and other care management materials.
b. Other medical secretarial duties as time allows.
5. Regular attendance on the job.
6. Perform other duties as delegated.
Essential Function(s): The basic job duties that an employee must be able to perform, with or without reasonable accommodations. If the position exists to perform that duty, it is an essential function. The essential function(s) for this position are 1 - 5 of the above Duties.
Non-Essential Function(s): Marginal duties that have limited or no consequences should the duties not be performed by the particular position. The non-essential function(s) for this position are 6 of the above Duties. % of Time: 50% Duty 1; 10% Duty 2; 30% Duty 3; 10% Duty 4
Minimum Qualifications (Pass/Fail): High school graduate OR equivalent; completion of a one (1) year medical secretarial course from an accredited higher education facility ( must attach transcript) OR one (1) year medical secretary work experience, within the past five (5) years; successfully pass a 55 wpm typing exam (via AssessTyping.com – Link to typing exam provided in the Supplemental Questions when applying for the position.) ; six (6) months education ( must attach transcript) and/or work experience in word processing and data entry. Knowledge, Skills & Abilities: Knowledge: and experience of office organizations. Skills: excellent secretarial, written and verbal communication skills. Abilities: attend training/meetings and/or make office deliveries on an as needed basis via a reliable means of transportation, analyze office data and design, prepare reports, complete forms and develop tracking systems, work well with others, willingness to follow rules and procedures and directives from supervisors. Preference for:
Education ( must attach transcript ) and/or work experience with Word, Excel; additional medical secretarial course work from an accredited higher education facility (must attach transcript ) or medical secretary work experience, within the past five (5) years, beyond the minimums credited above.
WORK HOURS, LOCATION, CONDITIONS AND EXTENT OF SUPERVISION :
Work Hours: The normal hours of work shall be eight (8) hours per day and forty (40) hours per week, Monday - Friday 8:00 am - 4:30 pm, overtime as necessary and approved.
Work Location: Itasca County Health and Human Services Department, Itasca Resource Center, 1209 SE 2nd Ave, Grand Rapids, MN
Work Conditions: These working conditions are a summary; review of the job duty analysis will provide more detailed description. CONTINUOUSLY: sitting, sensory (vision). FREQUENTLY: sensory (talk/speak). OCCASIONALLY: lift (low-level under 10 lbs), lift (mid-range under 10 lbs), lift (overhead under 10 lbs).
Extent of Supervision: Work is performed under the direct supervision of the IMCare Associate Director, indirect supervision of the County Based Purchasing Division Manager, Health and Human Services Director. Supervision of Others: none