Job Title: Administrative CoordinatorDepartment: Care ManagementLocation: Rochester General HospitalHours Per Week: Per DiemSchedule: Monday - Friday, occasional weekend coverage 8am - 4:30pm or 11am - 7:30pmSUMMARY
Participates and supports oversight of office processes of the Medical Management Department to maintain daily operations. Oversees the daily review process of the third party payors ensuring information is tracked and trended for reporting purposes. Acts as a liaison and collaborates with Patient Financial Services and Patient Access to assure authorization requirements of third party payors are maintained. Creates departmental reports for senior management.
RESPONSIBILITIES
- Oversees the review process of third party payors with oversight from the Director of Care Management. Provides daily oversight of the onsite review activities of third party payors identifying issues and cases for appeal.
- Collaborates and acts as liaison with Patient Access and Patient Financial Services to assure required authorizations requirements of Third Party Payors are maintained.
- Participates and supports the medical management department in the tracking, trending and reporting of appeals and charge recovery information.
- Conducts reviews of cost outliers and collaborates with other hospital operating areas to recover billed charges. Tracks reporting activities and prepares reports for management presentation.
- Provides ongoing support for the tracking and trending of the Reimbursement Specialist charge recovery activities.
- Assists with special projects including but not limited to data collection, compilation, and analysis as defined by management. Assists in the design and implementation of procedures and work plan for special medical management studies/reports required to ensure regulatory compliance.
- Provides ongoing support to the Utilization Committee as assigned.
- Provide ongoing resource and support to the department for clinical pathway process including tool development.
- Manages confidential information in accordance with RGHS policy and procedures.
- Screen patients at risk with no, or inadequate health insurance coverage for immediate and chronic needs.
- Implements plan to facilitate eligibility.
- Represents Rochester General Medical Group to all Affiliates, employees, families and the community, in a professional manner as demonstrated by feedback from these sources. Participates in community activities such as health fairs as directed by Grant Coordinator.
- Educates other hospital staff concerning job role, community-base, entitlement programs, etc.
- Performs other duties as required
PREFERRED QUALIFICATIONS
- Associate's degree preferred.
- Experience working in a healthcare administrative office preferred.
- Bilingual preferred.
- One year of experience with frail and elderly population preferred.
- Excellent oral and written communication and interpersonal skills highly desired.
- Strong organizational and problem solving skills highly desired.
- High level of proficiency with PC, software applications, and reporting tools highly desired.
- May need previously experience in CMS, Medicaid/Medicare billing, and other regulatory processes.
EDUCATION:
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$19.00 - $25.00
CITY:
Rochester
POSTAL CODE:
14621
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer. Minority/Female/Disability/Veterans by a prospective employee and/or employee's Physician or delegate will be considered for accommodations.