Medical Administration Specialist
Summary
| Title: | Medical Administration Specialist |
|---|---|
| ID: | 1199 |
| Location: | Bethesda, MD |
| Department: | Operations |
| Level of Experience : | Mid 4+ years |
Description
ROLE AND RESPONSIBILTIES:
The Medical Administration Specialist will provide medical appointment activities for the IRMAC.
QUALIFICATIONS
MANDATORY KNOWLEDGE AND SKILLS:
• Shall be able to read, write, speak, and understand English.
• Be a U.S Citizen.
• 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.
DUTIES AND RESPONSIBILITIES:
• Receive phone calls for appointment related request for the National Capital Region and the Pro-active line/POM.
• Via the POM, call the patient, schedule an appointment with PCM or Specialty clinic.
• If the patient accepts the appointment, the Appointment Coordinator, will document the encounter in CHCS and the IRMAC database.
• Document each attempt to contact the patient in the IRMAC database. (A total of two contact attempts should be made).
• 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 CHCS.
• Review health care delivery plans related to patient eligibility status in CHCS, EWRAS, and DEERS. Identifies market forces, patient and beneficiary demand and other 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, T-cons to doctors and administrators. Search all MTFs for possible capability, based on clinic guidance and available appointments within the CHCS.
• Accurately and courteously schedule appointments in accordance with NCR established standards, policies, and business rules, and the IRMAC Protocol Website for (600) plus 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 at the MTF.
• Gather demographic data information and enter into the patient’s authorized record of medical treatment, AHLTA
• 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 JRMS 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.
EDUCATION AND SPECIAL REQUIREMENTS:
• An associate’s degree or a minimum of (4) years’ experience in health care administration, business, information management, or a related discipline is required or any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position working in a MHS RM or Call Center.
• Equivalent combinations of education and experience may be qualifying if approved by the requesting location and the Contracting Officer.
UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:
Specific military systems include, but are not limited to: CHCS, MHS GENESIS, AHLTA, ICD programs, Microsoft Office TEAMS, Appointment booking software, Government data repositories such as P2R2 Virtual Analyst, M2 Data Mart, EDW, Population Health Operational Tracking and Optimization System, DMLSS, CMS, CAC Enabled Protocol Website, Medical Expense and Performance Reporting System, Defense Pharmacy System, Radiology and PACS, Automated Business System and Commanders’ Resource Integration System.
The Medical Administration Specialist will provide medical appointment activities for the IRMAC.
QUALIFICATIONS
MANDATORY KNOWLEDGE AND SKILLS:
• Shall be able to read, write, speak, and understand English.
• Be a U.S Citizen.
• 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.
DUTIES AND RESPONSIBILITIES:
• Receive phone calls for appointment related request for the National Capital Region and the Pro-active line/POM.
• Via the POM, call the patient, schedule an appointment with PCM or Specialty clinic.
• If the patient accepts the appointment, the Appointment Coordinator, will document the encounter in CHCS and the IRMAC database.
• Document each attempt to contact the patient in the IRMAC database. (A total of two contact attempts should be made).
• 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 CHCS.
• Review health care delivery plans related to patient eligibility status in CHCS, EWRAS, and DEERS. Identifies market forces, patient and beneficiary demand and other 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, T-cons to doctors and administrators. Search all MTFs for possible capability, based on clinic guidance and available appointments within the CHCS.
• Accurately and courteously schedule appointments in accordance with NCR established standards, policies, and business rules, and the IRMAC Protocol Website for (600) plus 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 at the MTF.
• Gather demographic data information and enter into the patient’s authorized record of medical treatment, AHLTA
• 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 JRMS 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.
EDUCATION AND SPECIAL REQUIREMENTS:
• An associate’s degree or a minimum of (4) years’ experience in health care administration, business, information management, or a related discipline is required or any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position working in a MHS RM or Call Center.
• Equivalent combinations of education and experience may be qualifying if approved by the requesting location and the Contracting Officer.
UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:
Specific military systems include, but are not limited to: CHCS, MHS GENESIS, AHLTA, ICD programs, Microsoft Office TEAMS, Appointment booking software, Government data repositories such as P2R2 Virtual Analyst, M2 Data Mart, EDW, Population Health Operational Tracking and Optimization System, DMLSS, CMS, CAC Enabled Protocol Website, Medical Expense and Performance Reporting System, Defense Pharmacy System, Radiology and PACS, Automated Business System and Commanders’ Resource Integration System.
