ESSENTIAL JOB FUNCTIONS:
- Transcribe case specific Physician Advisor rationales for use as denial rationale in provider and beneficiary notifications.
- Refer cases that require clarification or additional rational to the appropriate department Supervisor, Manager, Director or the Associate Medical Director.
- May be responsible for initial screening of medical records submitted for authorization of service, limited to the following tasks: Performance of review of service request for completeness of information;
- Collection and transfer of non-clinical data; Obtaining structured clinical data; and other review related activities that do not require evaluation or interpretation of clinical information. Seek direction from Clinical Review Specialist, Supervisor, Manager or Director for any clinical related questions or issues during the screening process.
- Proofread all outgoing correspondence, memos, forms, reports, etc. for accuracy and distribute.
- Scan, organize, file, maintain and track medical records, departmental records, correspondence, forms, etc. Purge files of inactive charts based on availability of space and AFMC retention/destruction procedures.
- Receive and distribute all correspondence including mail, fax, memos, reports and e-mail. Maintain contact lists to include addresses, phone numbers and e-mail addresses.
- Answer incoming calls and route to the proper person. Answer questions and take messages when needed. Upon request, verbally informs patients, facility personnel, the attending physician and other ordering providers, and health professionals of specific utilization management requirements and procedures. May inform callers of a list of procedure codes that do not require pre-certification. Refers all callers with clinical related questions or concerns to an appropriate clinical staff member
- Review, verify and edit the work produced by other staff members as directed.
- Serve as a back up to other team members as assigned or requested.
- Assist in training new team members.
- Perform data entry and prepare reports of review activity.
- Adhere to format, content and style guidelines, giving consideration to usability and ensuring accuracy, consistency, and quality.
- Follow AFMC, state and federal protocols regarding data confidentiality/security and HIPAA compliance.
- Communicate needs and requests to other team members as appropriate.
- Additional duties as assigned.
PHYSICAL AND SENSORY REQUIREMENTS (WITH OR WITHOUT THE AID OF MECHANICAL DEVICES):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to lift and transport 30 pounds. Must be capable of performing the essential functions of this job, with or without reasonable accommodations.
Required Skills
KNOWLEDGE, SKILLS AND ABILITIES:
- Intermediate skill level with MS Office (Excel, Word, PowerPoint, and Outlook).
- Type 50 wpm.
- Good command of the English language and knowledge of punctuation, grammar and spelling are required.
- Ability to maintain confidentiality.
- Strong oral and written communication skills.
- Customer service.
- Ability to meet deadlines.
- Attention to detail.
- Flexibility.
- Medical terminology.
- Ability to work collaboratively and independently to achieve stated goals.
- Initiative.
- Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients and the public.
- Ability to multitask.
- Ability to prioritize.
- Strong organizational skills.
- Professionalism.
- Time management skills.
Required Experience
EDUCATION:
Required: High School Diploma
Desirable: Associate’s degree or additional education in business
EXPERIENCE:
Required: Two (2) years’ health care experience
Equal Opportunity Employer/Veterans/Disabled EEO IS THE LAW
AFMC, Inc. is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability or any other status protected by federal, state and/or local law. AFMC invites any employee and/or applicant to review the Company’s Affirmative Action Plan. This plan is available for inspection upon request, which may be made in person or by telephone (501) 212-8798, by fax (501) 212-8797 or by U.S. mail Attn: Michael Dumas, 1020 West 4th Street, Suite 300, Little Rock, AR 72201.