Disability Reviewer Jobs in Boston, MA (NOW HIRING)

This requisition is being used as a sourcing tool and does not have an open vacancy. Your application to this req will add you to a pool of candidates for potential future openings. We still encourage you to apply directly to positions you feel best meet your background, as this will not replace your application for other openings. 

POSITION SUMMARY:

Under the general supervision of the Operations Manager, the Lead Disability Assistant is responsible for the coordination of administrative processing of disability determinations for all in and out of state contracts. This position is responsible for making strategic decisions on case assignment and for keeping cases on timeline. The Lead Disability Assistant is responsible for work flow management and training of Disability Assistants as well as performing those front line functions when necessary to maintain unit production standards. This position is the primary hub for all incoming/outgoing correspondence, disability supplements, and is the primary interface with clients, agencies, and DES staff regarding incoming and outgoing medical information, mail, transportation and records. Decisions made in this area directly impact the timeline for the disability review process, the workload of review staff, and the determination of benefits for all in and out of state agency applicants. The Lead Disability Assistant is a primary customer service interface for DES' SPMP with clients and external agencies.

ESSENTIAL FUNCTIONS:

• Manage unit work flow, assuring the proper numbers of Disability Assistants are assigned to each task on a daily basis.
• Train new and existing Disability Assistants in work functions and job duties.
• Monitor customer service phone queues for adequate coverage and provide call escalation response for front line staff.
• Monitor unit key performance indicators.
• Act as unit Disability Liaison for agency partner inquiries and issues.
• Track priority case requests and ensure prompt completion of work on such cases.
• Initial review of all disability supplements for accuracy, completeness, and alerting SPMP of priority cases and of important clinical information contained in cases.
• Make complex decisions regarding privacy matters associated with the client’s case, including determination of who DES may exchange information with regarding the client’s case, what information may be mailed, and what is required, by HIPAA, to allow conversations to take place. These decisions are conveyed to SPMP through detailed case notes and individual consultation.
• Determine if requests for information are legally complete, communicate with agencies about cases that do not meet HIPAA requirements for protected healthcare information and consult with SPMP about decisions regarding whether to return to cases to the agencies or clients for further development.
• Telephone contact with clinical treating sources to assure timely receipt of clinical information at the request and direction of SPMP.
• Review information in external databases such as the Massachusetts Medicaid Information System and MassHealth MA21databases in order to identify cases that SPMP could complete quickly.
• Coordinate transportation of clients to consultative examinations and provide feedback to SPMP on unusual circumstances that would impact the review process.
• Make decisions for rescheduling of clients’ clinical evaluations, based upon agency guidelines and provides input and feedback to SPMP. Explain complex state and federal regulations to clients, agencies and medical providers, answer disability process questions as they arise.
• Perform other duties as required.

REQUIRED QUALIFICATIONS:

• 2-Year College Degree in business or a related field
• 5-7 years of relevant office experience
• Demonstrated knowledge of medical terminology or willingness to take a course in Medical Terminology
• Knowledge of HIPAA laws and regulations especially as it refers to the confidentiality of PHI
• Knowledge of Microsoft Office products, Word, Excel, PowerPoint, and Outlook
• Demonstrated ability to monitor and generate reports
• Requires organizational and excellent interpersonal skills, oral and written communication skills necessary to interact with all levels of personnel.

PREFERRED QUALIFICATIONS:

• Experience in a medical setting
• Knowledge of DEScovery database
• Experience working as a member of an inbound/outbound call center
• Experience training staff on complex tasks
• Ability to create power point demonstrations for the purpose of training staff
• Thorough understanding of DES’s processes and procedures pertaining to all in and out of state contracts
• Ability to create processes and procedures for new programs as need arises.

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