- Posted: over a month ago
Job Title: Medical Services Specialist
Job ID: KR325954621
Location: Ada, OK
This position provides administrative, technical support and loyalty to the department in providing health care by outside providers to these beneficiaries. Works under the supervision of the department’s manager who provides general directions on the tasks to be accomplished, the employee exercises considerable independence and selflessness on all routine assignments and refers only the most difficult, controversial, and precedent type situations to the manager. Work is reviewed in terms of accuracy, quality, adherence with perseverance to established guidelines, and procedures.
What you will be doing:
- Procures health services from private providers through written contracts and agreements within established policies and procedures. Negotiates and awards purchases of health services within delegated guidelines and procedures.
- Maintains the fiscal records for medical and dental funds. Insure accurate posting of records and appropriate forms. Assures that clinical managers are kept informed on fund balances, authorizations and other pertinent information which applies to their program.
- Upon receipt of referrals and requests, performs preliminary reviews of other available alternate resources to the patient including Medicare, Medicaid, and private insurance carriers. Refers the more complex requests and referrals to the supervisor. Assist Medical staff in preparing referrals for submission to the Review Committee. Process requests according to determination made by committee.
- Provides initial and follow-up assistance for hospital admission in outside hospitals through contract providers. Notifies Case Manager of potential long term admissions.
- With stewardship, follow-up with those cases involving alternate third-party resources and assists patients in filing claims for medical services. Prepare to high costs cases for submission to the Catastrophic Health Emergency Fund CHEF for funding reimbursement.
- In the absence of the manager, is delegated the authority to approve requests and referrals involving the expenditure of funds.
- With servant leadership and maintaining cultural identity, communicates with vendor health facilities and providers regarding the department’s clerical and administrative processing and follow-up, provides direct assistance to patients concerning denials of payment for health care services on other matter to the department, provides patients and outside providers information related to the guidelines, policies and procedures. Schedule appointments or admission for patient and make travel arrangements if Necessary. Issues purchases orders and fax, mail or make arrangements for the patients to take to appropriate receiving department prior to receiving care. Get appointment information and paperwork to the patient in a timely manner. Work with the patient to reschedule any missed appointments.
- Develops in final form acknowledgments or appeals, composes draft responses to their correspondence and inquiries for signatures of the manager.
- In the absence of the clerk and/or in heavy workload periods, assists in answering the telephone, greeting visitors, maintain files or records.
- Assists in the receipt and distribution of incoming mail that requires comparing invoices and statements with pending authorizations forms, researches files to determine if patient was referred and financial commitments made.
- Type’s letters, forms, reports, and other written materials in final form with the responsibility for correct spelling, grammar, format, clarity and neatness.
- Work with other service units to process referrals for patients that live outside of our coverage area. This shall include faxing pertinent documents, telephone call and assisting with eligibility documentation.
- Be available to work a call back schedule as needed to provide 24-hour coverage.
- Performs other duties assigned.
What you must have:
- High school diploma, GED required with higher education courses preferred and one year of experience in office practices preferred.
- Clerical experience which provides knowledge of the processing of contractual health forms and paperwork.
- Proficient typing using automated word processing equipment is required.
- General knowledge of modern office practices and procedures, i.e. accounting, budgeting, purchasing, spelling, arithmetic business English and ability to follow oral and written instructions.
- Ability to make sound decisions in accordance with regulations. Knowledge of and ability to interpret policies and procedures and explain.
- Ability to establish and maintain good teamwork relationships with employees and the public with trust and respect.
- With honesty and integrity the ability to communicate effectively orally and in writing, some knowledge of tribal operations and program management.
- Knowledge of report writing and keeping statistical information. Knowledge of general office automation software such as personal computer.
For more information about TEEMA and to consider other career opportunities, please visit our website at www.teemagroup.com
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