Medical Administration Specialist Leads (Bethesda, MD)

Ivyhill Technologies has an immediate need for Medical Administration Specialist Leads for a project located in Bethesda, MD. The qualified candidates will provide oversight and management for the medical appointment activities in the Referral Management and Appointing Center.

Job Responsibilities:

1. Perform as Lead Medical Administration Specialist of all Medical Administration Specialist contract staff. Will serve as the subject matter expert on patient appointing/referral management and assist members of the call center with resolution of problems. Coordinate workload and assignments, training in tasks below, and ensuring adherence to all policies, procedures and protocols.
2. Recommend new ways to improve the Appointing and Referral Management Care Coordinator process. Implement approved methods. Validate and implement MTF policy in support of hospital accreditation program and quality improvement efforts.
3. Monitor the patient call center systems IVR, ACD, AHLTA, CHCS, Microsoft office suite, and all automated systems.
4. Review details of appointing rules for 600+ clinic and review referrals for suitability, administrative and clinical completeness. Coordinate the completion/booking for those prerequisites prior to the patient’s first appointment by contacting patient, RM/ROFR Health Coordinator, Product Line nurse, clinics, or providers as needed.
5. Verify patients are registered in CHCS and DEERS information and update demographic information as needed.
6. Review health care delivery plans related to patient eligibility status in CHCS, EWRAS, and DEERS. Identify market forces, patient and beneficiary demand and other issues impacting MTF capabilities, access and patient care compliance and/or quality of care and services. Projects and studies require analysis of inter-related issues of effectiveness, efficiency, productivity and customer satisfaction during both peacetime and wartime.
7. Coordinate the implementation process for reviewing and processing all patient referral requests from Humana. Provide recommendations and monitor process to insure staff adheres to the defined timelines for response (2 days response for routine/ 90 minute for urgent).
8. Coordinate process for research and communicate with requesting providers, Humana and others as needed to ensure complete medical information is available in order to make informed decisions about a Referral matter.
9. Enter or copy referrals in CHCS/ALHTA according to the IPM and the IRMAC standard operating procedures.
10. Provide recommendations to assist other ROFR staff when advising all categories of patients regarding their referrals and access to care options as related to their eligibility and beneficiary status.
11. Coordinate process for appointing and tracking referral in CHCS. Search all MTFs for availability, based on clinic guidance and available appointments within the CHCS.
12. Ensure equitable distribution of call center workload between MTFs and among the NCA appointing staff as required.
13. Ensure that Call Center phone system applications are running on their computers immediately upon logging in for work.
14. Schedule patients in CHCS for appointments at any MTF in the NCR eMSM based upon Appointing Business Rules and protocols.
15. Verify patients are registered in CHCS; if not appointing staff will register patient in CHCS based on DEERS information; update patient demographics information as needed.
16. Assist with other duties within the Appointing or Referral Management Office related to appointing or the processing of referrals to Direct Care MTFs and Civilian Care per customer's responsibilities.
17. Use business intelligence applications to extract, manipulate, format, and from various Government computer systems. May maintain metadata, or design basic databases.
18. Review and prepare monthly Appointing reports through the CMS, DPA system and the AVAYA Contact Recorder.
19. Research and analyze complex health care operations. Prepare presentations, project papers, staff and biometric reports and other medical administrative correspondence; deliver to senior MTF management.
20. Using analytical skills and tested methodologies, conduct studies in support of various projects, program, processes or initiatives covering all aspects of military health care activities. Projects may be complicated by regulatory requirements, long-range projections and objectives, and/or political and economic uncertainties.
21. Maintain effective communication with appropriate staff and work closely with technical staff to ensure efficient operation.
22. Perform office administrative practices and procedures, including the use of standard office equipment to accomplish clerical, statistical and data entry tasks in support of the administrative duties as assigned.
23. Ensure equitable distribution of appointing workload between teams and among the NCA appointing staff as required.
24. Notify and direct professional staff and other medical administrative personnel regarding process, policy and requirements. Assist with training and orientation of new Medical Appointing Coordinators as needed. Ensure that the appointing staff is trained and demonstrate understanding of the appointing process as required.
25. Maintain effective communication with appropriate staff and work closely with technical staff to ensure efficient operation.
26. Monitor, document and report time and attendance to the customer and contract vendor.
27. Travel as requested.

Requirements

1. Must be able to read, write, speak, and understand English.
2. Be a U.S Citizen.
3. Mastery level knowledge of military Medical Services, civilian health care delivery systems, military management health care principles and techniques, TRICARE Managed Health Support contracts and clinical and financial systems, policies, procedures and standards.
4. Have experience using the CHCS and AHLTA.
5. Knowledge of medical information systems and automated analytical tools and software (clinical and financial models). Expertise in quantitative and qualitative analyses techniques using various military computer systems.
6. Possess knowledge of medical terminology, release of medical information and legal ethics.
7. Be able to perform accurate data entry and attention to detail.
8. Possess knowledge of standard office administrative practices and procedures, including the use of standard office equipment to accomplish clerical, statistical, and data entry tasks in the support of the administrative work of the office.
9. Have superior customer service and organizational skills.
10. Effective communication skills both orally and in writing, as well as the ability to make sound judgments. Research of operational activities may require coordination with high level officials in civilian and federal agencies.
11. Be highly organized, detail-oriented with strong organizational skills and have the ability to work effectively and independently at home, with a positive attitude.
12. Must display proficiency in the Microsoft Suite of Products, including, Word, Excel, PowerPoint, Access,
    Outlook (email), and Internet familiarity is required. This includes various microcomputer equipment for
    appointment scheduling, and be able to input, retrieve and format documentation.
13. Must display knowledge and skills working in a medical environment, customer service focused Call
    Center, preferably with emphasis on appointment scheduling and referral management.
14. Thorough knowledge of DoD, Federal, State, non-profit healthcare systems and organizations, to include DoD Tri-Service Military Healthcare Systems, TRICARE purchased care system, Medicare, Medicaid, VA, Public Health Department, and Regional and local support services.
15. Thorough knowledge of DoD, Air Force, Army or Navy and AAAHC standards, the MHS Care System, TRICARE, medical terminology, release of medical information, and medical and legal ethics in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
16. Exceptional customer service skills in dealing with irate patients, staff, beneficiaries and leadership.
17. Demonstrated knowledge of basic Medical Terminology: a Basic Medical Terminology Course is preferred,
    but not required.
18. Excellent office administrative practices and procedures, including the use of standard office equipment to accomplish clerical, statistical and data entry tasks in support of the administrative work of the office.
19. Expert understanding of CHCS, AHLTA, and Appointment Call center Software, IVR, ACD, and AVAYA
    systems.
20. Must have superior customer service and organizational skills.
21. Must have strong verbal and written communication skills and sound judgment.

Education:

1. A bachelor’s degree or a minimum of (6) years’ experience in health care administration, business, information management, or a related discipline is required, and/or any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position working in a MHS RM or Call Center.
2. Equivalent combinations of education and experience may be qualifying if approved by the requesting location and the Contracting Officer.

Benefits

Ivyhill Technologies offers a full benefits packet to include vacation and sick leave; medical, dental and vision insurance; life and accidental death and dismemberment insurance; short and long term disability; and a 401k Plan.

Ivyhill is an equal opportunity employer. In compliance with Federal and State Equal Opportunity Laws, qualified applicants are considered for all positions applied for without regard to race, color, religion, sex (including pregnancy and gender identity) , national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, veteran status or any other legally protected status.