Provider Management Coordinator - University of Massachusetts Medical School - Shrewsbury, MA

Provider Management Coordinator - University of Massachusetts Medical School - Shrewsbury, MA -

Underneath the overall supervision of the Operations and Coaching Specialist or designee, this place is answerable for coordinating shopper appointments for Consultative Examinations (CE) by medical and psychiatric suppliers inside the Commonwealth of Massachusetts. This place performs complicated and different duties related to the coordination of departmental administrative features by means of the use of the DEScovery pc system in addition to Phrase, Excel, Entry and Outlook purposes. The Provider Management Coordinator is the first contact for the group-based mostly DES supplier community, interfacing between incapacity reviewers requesting examinations and the CE community supplier performing examinations. This place makes complicated selections relating to protected healthcare info (PHI) based mostly on the Federal laws relating to the safety of well being info underneath the Well being Info Portability and Accountability Act of 1996 (HIPAA) and the Well being Info Know-how for Financial and Medical Well being (HITECH) Act.

As well as, this place conducts enterprise throughout all departments inside DES. The Provider Management Coordinator is liable for all features involving suppliers for the DES CE supplier panel, comprised of roughly 150 clinicians situated all through the Commonwealth of Massachusetts. Selections made on this space immediately influence the timeline for the incapacity assessment course of and for the willpower of advantages for MassHealth and different company candidates. This place is the first hub for all coordination of medical and psychiatric examinations, and interacts with shoppers, suppliers, and DES employees relating to establishing shopper appointments.

Obligations:
MAJOR RESPONSIBILITIES:
Function a liaison between our suppliers & DES employees.
Coordinate the complicated scheduling of medical, psychiatric and studying incapacity examinations for shopper’s making use of for MassHealth, Division of Transitional Help or State Complement Program incapacity advantages.
Assessment request for appointments to make sure that an applicable supplier is chosen based mostly on specialty of the examination, the geographical location of the shopper, the supplier’s availability and the shopper’s choice.
Evaluation and edit CPT codes assigned to ancillary checks to make sure accuracy and consistency inside the DES tips and supplier capabilities.
Critically assess DTA shopper’s from the pool of CE examination requests to find out who may profit from their appointment being organized at an area DTA workplace. Qualifying shoppers shall be contacted by a telephone name and/or letter to rearrange these CE exams. Coordinates these appointments intently with the CE supplier and the suitable DTA workplace.
Keep statistics on shopper participation and make suggestions for enchancment.
Collaborate with CE suppliers to triage issues associated to shopper’s exams, involving different DES employees, as wanted, to help in drawback resolutions.
Forecasts and Identifies alternatives for a number of appointments with similar supplier to realize potential value financial savings with a block sequence association with interpreter service distributors. .
Make complicated selections relating to privateness issues related to the shopper’s case, together with willpower of who DES might change info with relating to the shopper’s case, what info could also be mailed, and what’s required, by HIPAA, to permit conversations to happen.
Corresponds and communicates every day with advocates and businesses dealing with delicate and confidential data/info for shoppers at DES. Communicates confidential info by way of telephones & safe e mail, assuring there’s all the time satisfactory protection
Knowledge enters appointment info into DEScovery or MedQuest system in a well timed method. Additionally enters scheduling knowledge into different knowledge bases reminiscent of Studying Disabilities and State Complement Program. Liable for alerting incapacity reviewers of incoming CE reviews for any DES program.
Generate stories in preparation for evaluation and graphical show. Organizes info into spreadsheet format for knowledge collections.
Evaluate supplier funds month-to-month & resolve monetary accounting questions with suppliers. Coordinate inbound calls from shoppers, suppliers and businesses in an skilled method with wonderful communication & organizational expertise and phone etiquette & resolve any points they could have.
Collaborate with a number of interpreter providers by requesting and or cancelling interpreters for shoppers and getting into the knowledge on an excel spreadsheet. Be sure that digital knowledge transmission of day by day interpreter is carried out in a safe method, based on DES & CWM knowledge safety insurance policies and procedures.
Present instructions to shoppers for CE appointments, and useful workplace descriptions for his or her appointments. In a single day and categorical mail shopper letters/supplier letters, English and or Spanish.
Adjust to established insurance policies, well being & security laws and necessities, procedures and division aims.
Performs scanning features, faxing, scanning of every day supplier schedules, invoices for suppliers, shopper letter, letter to suppliers, dictations to signal and different paperwork each day.
Monitor & consider workplace procedures and determine areas for enchancment. Provoke & implement new procedures as wanted.
Carry out different duties as assigned.

Qualifications:
REQUIRED QUALIFICATIONS:
Associates diploma in enterprise or associated subject and three years of related complicated workplace expertise.
Demonstrated information of medical terminology or willingness to take a course in Medical Terminology.
Information of HIPAA legal guidelines and laws particularly because it refers back to the confidentiality of PHI.
Information of Microsoft Workplace merchandise, Phrase, Excel, PowerPoint, and Outlook.
Demonstrated capacity to watch, generate, acquire, and distribute stories.
Should possess demonstrated verbal and non-verbal communication expertise essential to work successfully with numerous inhabitants, each on the phone and in individual.
Consideration to element, expertise with monitoring studies.

PREFERRED QUALIFICATIONS:
Expertise in a excessive functioning, multi-faceted, medical setting most popular.
Potential to independently manage and prioritize work obligations and the demonstrated means to use crucial considering expertise to unravel issues.
Familiarity with medical terminology and CPT codes strongly most popular
Wonderful communication and interpersonal expertise
Information of DES knowledge safety procedures, requirements and necessities relating to the confidentiality of protected well being info.

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