Job Description
Job Description:
Summary:
Responsible for managing and providing divisional support to all Medical Records Unit (MRU) activities such as medical record requests, receipts, research and tracking through the medical record database. Research Facets, Plan Connexion processing system and control workflow to ensure intakes are handled timely by the appropriate area, including BlueCard and Local claims, to ensure performance metrics are met.
Essential Accountabilities:
Level I
•\tResponsible for the quality assurance of all internal and external medical record requests and the determination of appropriate outgoing communication.
•\tReview medical record receipts including unsolicited medical records for completeness and determine appropriate workflow.
•\tInterface with and extract data from the Facets and/or Plan Connexion processing systems to prepare and complete medical record reports.
•\tProcess and maintain current and accurate Department of Labor medical record requests.
•\tAssist Claim Examiners with questions.
•\tInitiate and participate in learning opportunities around regulations, systems, procedures and skills needed for the role.
•\tConsistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
•\tMaintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
•\tRegular and reliable attendance is expected and required.
•\tPerforms other functions as assigned by management.
Level II (in addition to Level I Accountabilities)
•\tEfficiently resolve escalated organizational requests and inquiries.
•\tIdentify trends, determine root cause and recommend potential solution.
•\tResearch, track and resolve Department of Labor medical record requests for Home plan including Plan Connexion.
•\tResolve all types of medical record review transactions which includes Host and Local claims.
•\tObserve fluctuations in inventory levels and escalate to Level III for investigation.
•\tTrain Level I employees on department processes/functions.
Level III (in addition to Level II Accountabilities)
•\tResolve medical record review transactions which includes Host, Home and Local claims.
•\tIdentify trends, determine root cause, communicate risk to leadership and initiate action for resolution.
•\tMentor and train on lines of business within MRU.
•\tSupport analytical work.
•\tServe as subject matter expert testing new system implementations and improvements.
•\tIdentify, recommend and initiate process as well as desk level documentation improvements.
•\tProvide productional support to areas outside of MRU based on business need.
•\tParticipate as subject matter expert in project and process improvement related work for MRU.
•\tResponsible for maintenance of the Medical Record Database.
•\tMonitoring inventory fluctuations within workstreams to coordinate, delegate and execute inventory control/assignment plan.
•\tCoordinate invoicing for payment of medical records.
•\tLearn and support areas outside of MRU.
•\tProvide resolution of complex and escalated issues.
Minimum Qualifications:
NOTE:
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
•\tHigh school diploma or equivalent required.
•\tOffice experience and claims background preferred.
•\tBasic computer skills required including the ability to navigate in a Windows environment. Able to work between multiple programs and applications at the same time.
•\tStrong self-management skills including but not limited to reasoning, problem-solving, change management, communication, time management and organizational skills.
•\tAbility to meet minimum performance metrics.
•\tAbility to arrive on time at work and as scheduled.
Level II (in addition to Level I Qualifications)
•\tAbility to analyst data and identify trends.
•\tAbility to mentor and train.
•\tExceed performance expectations for a minimum of one (1) year and/or meet performance expectations for three (3) years as a Level I.
Level III (in addition to Level I Qualifications)
•\tDemonstrated in-depth knowledge of, and ability to coach/support MRU on all lines of business and other areas within Claims.
•\tExceed performance expectations for a minimum of three (3) years and/or meet performance expectations for five (5) years.
Physical Requirements:
•\tThe ability to hear, understand, and speak clearly while using a phone, with or without a headset.
•\tAbility to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
•\tAbility to travel across the Health Plan service region for meetings and/or trainings as needed.
************
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation Range(s):
Level I: Grade N2: Minimum: $20.00 - Maximum: $24.43
Level II: Grade: N3: Minimum: $20.40 - Maximum: $27.00
Level III: Grade: N4: Minimum: $20.80 - Maximum: $30.80
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Summary:
Responsible for managing and providing divisional support to all Medical Records Unit (MRU) activities such as medical record requests, receipts, research and tracking through the medical record database. Research Facets, Plan Connexion processing system and control workflow to ensure intakes are handled timely by the appropriate area, including BlueCard and Local claims, to ensure performance metrics are met.
Essential Accountabilities:
Level I
•\tResponsible for the quality assurance of all internal and external medical record requests and the determination of appropriate outgoing communication.
•\tReview medical record receipts including unsolicited medical records for completeness and determine appropriate workflow.
•\tInterface with and extract data from the Facets and/or Plan Connexion processing systems to prepare and complete medical record reports.
•\tProcess and maintain current and accurate Department of Labor medical record requests.
•\tAssist Claim Examiners with questions.
•\tInitiate and participate in learning opportunities around regulations, systems, procedures and skills needed for the role.
•\tConsistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
•\tMaintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
•\tRegular and reliable attendance is expected and required.
•\tPerforms other functions as assigned by management.
Level II (in addition to Level I Accountabilities)
•\tEfficiently resolve escalated organizational requests and inquiries.
•\tIdentify trends, determine root cause and recommend potential solution.
•\tResearch, track and resolve Department of Labor medical record requests for Home plan including Plan Connexion.
•\tResolve all types of medical record review transactions which includes Host and Local claims.
•\tObserve fluctuations in inventory levels and escalate to Level III for investigation.
•\tTrain Level I employees on department processes/functions.
Level III (in addition to Level II Accountabilities)
•\tResolve medical record review transactions which includes Host, Home and Local claims.
•\tIdentify trends, determine root cause, communicate risk to leadership and initiate action for resolution.
•\tMentor and train on lines of business within MRU.
•\tSupport analytical work.
•\tServe as subject matter expert testing new system implementations and improvements.
•\tIdentify, recommend and initiate process as well as desk level documentation improvements.
•\tProvide productional support to areas outside of MRU based on business need.
•\tParticipate as subject matter expert in project and process improvement related work for MRU.
•\tResponsible for maintenance of the Medical Record Database.
•\tMonitoring inventory fluctuations within workstreams to coordinate, delegate and execute inventory control/assignment plan.
•\tCoordinate invoicing for payment of medical records.
•\tLearn and support areas outside of MRU.
•\tProvide resolution of complex and escalated issues.
Minimum Qualifications:
NOTE:
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
•\tHigh school diploma or equivalent required.
•\tOffice experience and claims background preferred.
•\tBasic computer skills required including the ability to navigate in a Windows environment. Able to work between multiple programs and applications at the same time.
•\tStrong self-management skills including but not limited to reasoning, problem-solving, change management, communication, time management and organizational skills.
•\tAbility to meet minimum performance metrics.
•\tAbility to arrive on time at work and as scheduled.
Level II (in addition to Level I Qualifications)
•\tAbility to analyst data and identify trends.
•\tAbility to mentor and train.
•\tExceed performance expectations for a minimum of one (1) year and/or meet performance expectations for three (3) years as a Level I.
Level III (in addition to Level I Qualifications)
•\tDemonstrated in-depth knowledge of, and ability to coach/support MRU on all lines of business and other areas within Claims.
•\tExceed performance expectations for a minimum of three (3) years and/or meet performance expectations for five (5) years.
Physical Requirements:
•\tThe ability to hear, understand, and speak clearly while using a phone, with or without a headset.
•\tAbility to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
•\tAbility to travel across the Health Plan service region for meetings and/or trainings as needed.
************
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Compensation Range(s):
Level I: Grade N2: Minimum: $20.00 - Maximum: $24.43
Level II: Grade: N3: Minimum: $20.40 - Maximum: $27.00
Level III: Grade: N4: Minimum: $20.80 - Maximum: $30.80
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
About CDPHP