The HCQ Provider Services Coordinator develops relationships with physicians providing care to the Medicare Advantage patients of MDX Hawaii clients through clinical and programmatic assistance to the physician and staff. As part of this relationship, the Provider Services Coordinator educates providers about the Clinical Quality and Documentation & Coding Improvement program and data reporting requirements, participates in outreach activities to providers and helps facilitate and participate in provider education sessions.
TYPICAL WORKING CONDITIONS:
Field based position; subject to both inside environmental conditions (temperature fluctuations of air-conditioned office) and outside environmental conditions (weather fluctuations). Incumbent will work in the office setting, provider office settings and other locations where meetings, demonstrations, evaluations and/or training sessions are performed. May require travel via own automobile or day/overnight travel to the Neighbor Islands and/or the Mainland.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
- Monitors and performs follow up with providers and clinics for completion of chart retrieval, Annual Wellness Assessments and quality measures. Provides orientation, training, up to date information and support as needed to these offices. Assists physicians in patient follow up as necessary to ensure patient compliance, understanding and cooperation.
- Meets the contractual requirements for retrieval of Annual Wellness Assessments by the specified contract deadline.
- Manages the assigned territories or list of providers and makes recommendations for improvements as needed.
- Maintains required number of follow up visits each week; Minimum of 12 visits per week and high range of 20+ visits per week
- Completes daily provider activity log documentation and submits weekly.
- Represents MDX Hawai‘i at health care related affairs, provider meetings, lectures or presentations as assigned.
- Participates in liaison meetings between MDX Hawai‘i functional areas.
- Plans and coordinates provider meetings, seminar and direct mail activities as assigned.
- Transports clerks to and from physician offices to scan or copy charts as needed.
- Responds to inquiries from physician and clinic offices.
- Follows all Company/Department policies and procedures, including but not limited to personnel policies, safety policies and operational policies as communicated by management.
- Represents the Company in a professional manner at all times when dealing with both internal and external physicians, facilities and staff.
- Performs other duties as assigned.
MENTAL, PHYSICAL AND COMMUNICATION DEMANDS:
- Ability to multitask and function in a high volume/busy environment. Ability to work calmly under pressure and appropriately plan, prioritize, organize and carry out tasks and responsibilities. Ability to work unsupervised, taking responsibility for own actions.
- Good decision making and communicating skills. Ability to motivate people. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, correspondence and procedure manuals. Ability to speak effectively before groups of customers or employees of organization. Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.
- Ability to maintain clinical dialogue with physicians regarding program requirements.
- Requires the ability to travel throughout Oahu via automobile and airplane to meet with individual providers or groups of providers.
- Ability to work productively in a collaborative environment.
EDUCATION AND/OR EXPERIENCE:
- Bachelor’s degree in business or health care administration or related field or comparable education and experience.
- Registered Nurse, Licensed Practical Nurse, or Physician Assistant certification preferred, but not required.
- Two years experience in managed care or the health care industry with focus on government programs strongly preferred.
- Ability to calculate figures and amounts such as discounts, proportions, and percentages.
- Ability to apply concepts such as factions, percentages, ratios, and proportions to practical situations.
- Ability to understand basic billing and coding concepts, basic clinical terminology, pathology, anatomy and physiology.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
LICENSES, CERTIFICATIONS, REGISTRATIONS:
- Current/valid Hawai‘i Driver’s License.
- Proof of Hawai‘i No-Fault Auto Insurance.
- Clean driving record as evidenced by a recent driver’s abstract (to be provided by the employee).
OTHER SKILLS AND ABILITIES:
- Excellent PC skills.
- Experience in Microsoft Office Window’s based applications (e.g. Microsoft Word, Excel, Access and PowerPoint).
- Ability to work nights and/or weekends as required.
- Ability to learn and become a skilled user of the company’s proprietary database.