Medical Administration Specialist

Quality Innovation, Inc.
Bethesda, MD
Jan 26, 2022
Jan 28, 2022
Full Time
Medical Administration Specialist The Medical Administration Specialist will provide medical appointment activities.Qualifications: 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. Have experience using the CHCS and AHLTA. 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. Possess knowledge of medical terminology, release of medical information and legal ethics. Be able to perform accurate data entry and attention to detail. 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. Have superior customer service and organizational skills. 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. Be highly organized, detail-oriented with strong organizational skills and have the ability to work effectively and independently at home, with a positive attitude. Must have working 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. Must have knowledge of DOD, Air Force, Army or Navy standards and privacy and confidentiality requirements (HIPAA). Standard 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. Knowledge of Microsoft Office programs, Outlook (email), and Internet familiarity is required. This includes various microcomputer equipment for appointment scheduling, and provider must be able to input, retrieve and format documentation. Must have superior customer service and organizational skills Responsibilities include: Receive phone calls for appointment related request for the National Capital Region and the Pro-active line/POM. Call patients and schedule an appointment with PCM or Specialty clinic. If the patient accepts the appointment, the Appointment Coordinator, will document the encounter in electronic systems and database. Document each attempt to contact the patient in the IRMAC database. Document patients who decline offered appointments in order to update their referral record accordingly. Determine appointment needs according to local and regional managed care rules. Validates and implements MTF policy in support of hospital accreditation program and quality improvement efforts. Search for patient demographics in electronic system. Review health care delivery plans related to patient eligibility status in various electronic systems of record. Identifies market forces, patient and beneficiary demand and 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. Conduct a DEERS eligibility check on 100% of patients who request an appointment. Correct demographic data, by performing a mini registration update in DEERS (as necessary). Provide clinic appointment access, teleconference to doctors and administrators. Search all MTFs for possible capability, based on clinic guidance and available appointments within the electronic system of record. Accurately and courteously schedule appointments in accordance with NCR established standards, policies, and business rules, and clinic SOP'S. Spot check scheduled appointments when required. Refer patients to appropriate MTF and provide advice on location of clinics. Prioritize beneficiary appointments to be scheduled in accordance with Tricare Access to Care Standards and written guidelines. Verify and document eligibility of each patient to whom services are scheduled. Direct all questions regarding beneficiary eligibility to the Chief, PAD or designated personnel at the MTF. Gather demographic data information and enter into the patient's authorized record of medical treatment. Send telephone consults to designated triage nurse for PCM immediately following the completion of a Telephone consult. Notify and direct professional staff and other medical administrative personnel regarding process, policy and requirements. Upon request by the Medical Administrative Team Leader, provide occasional value-added support by assuming Team Lead responsibilities. Use business intelligence applications to extract, manipulate, format, and from various Government computer systems. May maintain metadata, or design basic databases. When requested, and patient is registered in Relay Health, the Appointment Coordinator will book the appointment in the clinic nearest to the patient's residence. When requested, send the patient a relay health email message with appointment date, time, clinic provider, and any special/clinic instructions. When requested, document in the database indicating that a Relay Health email was sent to the patient. 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. 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. Requirements: Education/Experience - Some college Security - Must be able to pass a national security background check for access into military electronic systems. Must maintain active and valid HIPAA certification. Shall be able to read, write, speak, and understand English. Be a US Citizen. Must be able to operate a personal computer to input, store, retrieve and manipulate data for various reports as required. Must be able to use various software programs to maintain database files and prepare reports, including Microsoft Word, Excel, PowerPoint and Outlook.Quality Innovation, Inc. is an Equal Opportunity Employer and as such abides by the requirements of 41 CFR || 60-1.4(a), 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, gender identity or sexual orientation.XJ6

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