This position provides administrative support (e.g., scheduling meetings, transcription of meeting minutes, clinical project assistance, making administrative outbound calls, generation of clinical correspondence, etc.) for the Clinical Operations Team, including supporting all clinically related administrative tasks for the Medical Services department, the Part D team, the Provider Relations department, the Medical Director, the Vice-President of Clinical Operations, and the Quality Improvement Manager.
Education, Certifications, Licenses and Experience
The position requires education and experience equivalent to an associate’s degree and at least three years of administrative experience in a clinical or medical setting. Proficiency in business communication and the use of medical terminology is required; experience with Medicare is desired. The position requires proficiency in the use of personal computers and typical business software applications including word processing, spreadsheets, databases, Internet/email, electronic calendar, and presentation/graphic design applications.
Primary Duties and Responsibilities:
Administrative Support (95% of time)
Provides administrative support for Clinical Operations including, but not limited to:
Medical Services Department (50%)
- Generates daily inpatient and outpatient service reports for the Medical Services Team.
- Performs daily outbound calls to verify discharge status from inpatient facilities, entering notes on each member discharge into the case management, and/or claims electronic data system to ensure accurate documentation of discharge dates. Distributes daily report to clinicians for daily outbound discharge calls to members. Generates and mails discharge authorization letters.
- Checks phone queue and email queue messages daily, accurately transcribes member and provider requests, and distributes requests to clinicians.
- Disseminates written requests for medical services, including those faxed and mailed, to clinicians for follow-up.
- Generates standardized case management program, and medical authorization letters, from the letter queues, for the Medical Services department, and transcribes any unique correspondence from notes or transcription equipment to prepare official documents (e.g., medical reviews, pre-authorization letters, responses to member questions, etc.). This includes researching medical files and other source information to confirm dates, procedures, names, and other details and proofing all documents for spelling, grammar, Centers for Medicaid and Medicare (CMS) compliance, and clarity.
- Reviews all clinical operations administrative documents, forms, and related operational policies to ensure compliance with CMS regulations and current guidance, which includes updating forms for clarity and ease of use, tracking versions and network directories/folders, updating directories with new contact information, and distributing updated forms and directories to staff and providers.
Clinical Operations (45%)
Other Duties as Assigned (5% of time)
(Includes Medical Services, Outbound Call Center, Part D, Quality Improvement, Medical Director, and Provider Relations Departments)
- Coordinates cross-departmental clinical operations activities as needed, including training, communication, organizing internal and external committee meetings, statewide provider workshops, and forums; preparing information e.g., reports, handouts, editing PowerPoint presentations; and taking meeting minutes to accurately reflect and document all activities.
- Supports organizational goals and objectives, and business improvement project outreach projects, inclusive of generating documents, performing mail merges, and preparing status reports and graphs to demonstrate goal activity and return on investment (ROI) for such projects.
- Assists with administrative coordination in medical records review for risk improvement, Healthcare Effectiveness Data and Information Set (HEDIS), and other clinical initiatives.
- Coordinates executive scheduling including making travel arrangements and reservations, maintaining schedules, coordinating appointments, and preparing information and materials.
- Opens, sorts, and distributes executive correspondence, faxes, and email including preparing responses to routine inquiries, and reading incoming memos, submissions, and reports to determine their significance and plan their distribution.
- Reviews office administration practices (e.g. mailing, data updating and retrieval, office practices, etc.) to identify and recommend more efficient procedures (e.g., more efficient mailings using postcards, workflow, reporting procedures, etc.).
- Operates word processing, spreadsheet, and database software to compile data, prepare reports, and execute mail merges. This includes compiling information on spreadsheets using formulas, graphs, and charts; extracting information from databases to prepare mail merges; verifying the accuracy of information; and correcting data (e.g., updating information or eliminating redundant data).
- Files and retrieves corporate documents, records, and reports as needed, ensuring accuracy, compliance with records retention and confidentiality.
- Provides consistent and reliable office coverage through regular and timely attendance between 8:00 a.m. and 5:00 p.m. Monday through Friday.
Performs a variety of other administrative work as assigned. Participates in the development of Clinical Operations programs as needed (e.g. as part of a task-oriented workgroup or operational team) for process improvement and project development. This may include testing of systems, making recommendations on new systems and procedures, and auditing of selected medical authorizations for data entry accuracy, policy and procedure adherence, and consistent decision making; coordinates special projects and events, attends training and continuing education, and provides backup and coverage for Department staff as assigned.
The above statements are intended to describe the general nature and level of work being performed by employees in this position. They are not intended to be an exhaustive list of all duties, responsibilities, and qualifications of employees assigned to this job.
The physical demands 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.
While performing the duties of this job, the employee is regularly required to sit. The employee is frequently required to stand, walk, talk and hear including communicating effectively over the phone and in person. The employee must occasionally lift and/or move up to 25 pounds. Regular and timely attendance between 8:00 a.m. and 5:00 p.m. Monday through Friday is an essential requirement of the job. The noise level in the work environment is usually moderate.
Knowledge, Skills and Abilities
The position requires knowledge of office administration principles, clerical business practices; business English, grammar and spelling; alpha/numeric filing methods and systems; technical writing methods; customer service methods and techniques; phone system use, applied use of medical terminology; and meeting and travel planning.
The position requires excellent interpersonal and communication skills. The position requires skill in accurate data entry, keyboarding, operating computer programs efficiently, including skill in the use of personal computers and typical business software applications including word processing, spreadsheets, databases, Internet/email, electronic calendar, and presentation/graphic design applications.
The position requires the incumbent to be highly self-motivated, self-directed and willing to adapt and contribute in a team environment; to effectively prioritize and execute tasks under tight deadlines and manage a high volume of work; and to provide effective services to a variety of customers; the ability to work well with people under demanding conditions; develop and maintain effective working relationships with a variety of individuals; work independently and with initiative; identify when to ask for help, and be willing to ask for help when appropriate; and to follow procedures expected of all administrative staff and serve company staff and customers in a professional manner. The position requires proven proficiency in accomplishing a great deal of work in limited time, being flexible, and in multi-tasking. Requires the ability to read and interpret medical records, accurately reflect medical determinations, and prioritize work based on clinical information. Requires the ability to interpret CMS guidance and prioritize work based on communication from CMS.