Coordinator, Medical Allocation Services
- Career Level
- Not Specified
York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
Assists the Medical Allocation/Medicare Secondary Payer Compliance Team with the daily operations of the department and special projects as the VP of Managed Care Programs request. Receives the initial referrals for the business unit and completes the initial steps in the MAS workflow process; as well as receives assignments related to assisting the medical allocators with tasks in effort to efficiently and effectively complete the work assignments.
ESSENTIAL JOB RESPONSIBILITIES:
- Opens a new trade file for new referrals or enter note in existing claim file to confirm receipt of referral
- Complete demographics for MSA/MCP at time of assignment
- Organizes medical records in chronological order for all referrals, and attach to file for the MAS Allocator. Prior to submitting for assignment to the medical allocators, or the medical allocation services coordinator for completion, the Medical Allocation Services Coordinator performs a quality review of the file records to ensure all records are present to proceed with completion of referral. A quality review checklist is provided as a tool to consistently and accurately perform this task.
- When there are insufficient medical records to proceed with the referral process, the MAS Coordinator will request the referring party obtain the needed documentation; as well as notify them the product (MSA, MCP, etc.) will not be completed until receipt of the same
- Reports to the Medicare Coordination of Benefits Contractor (COBC) injured party information needed when a Medicare Set-Aside referral is received.
- Upon approval from the claims adjuster, coordinate to obtaining of signed consent forms from the claimant or their attorney in order to expedite the process of future submission or any other activity that may require these said consent forms
- Requests the medication detail reports for the last two years of medicals from the respective pharmacy
- Assists in follow up for all referrals on hold as indicated by the MAS allocator. Entails calling or emailing adjuster, attorney or necessary party to ensure the MAS Allocator gets information needed that has considered their referral on hold
- Conducts Medicare and Social Security Disability Insurance (SSDI) Verifications upon request from direct supervisor, or when the Medical Submissions and Compliance (MSC) Coordinator is unable to complete these verifications due to vacation time
- Assists the MSC Coordinator with the MSA CMS Submission process as instructed by their direct supervisor
- Incoming mail: receives, stamps, attaches and notifies adjuster, allocator or other applicable parties involved of receipt of mail
- Outgoing mail: receives mail from the MAS team and sends out at the appropriate level of priority
- Faxes documentation for MSA team as needed
- Orders and maintains needed office supplies for Medical Allocation Services team
Maintains records MSA and MCP Reports in Word format for the Medical Allocation Services division
Prepares memorandums, meeting agendas and minutes for the Medical Allocation Services team as instructed by the VP of Managed Care Programs
- Assists with special projects as needed.
Organizes and maintains electronic data file system for Medical Allocation Services division
Assist in marketing efforts as needed
- When the MSC Coordinator is out of the office: Receives all incoming referrals of the various product lines via email (firstname.lastname@example.org ). On occasion a referral may be received via US postal, facsimile (noted above), or direct email
- When the MSC Coordinator is out of the office: Logs the referrals and their ongoing status on the Medical Allocation Services Production Report and Reporting Log
- When the MSC Coordinator is out of the office: Sorts and distributes the referrals to the medical allocation team member assigned on the date of receipt of referral or following business day if received after 4:00 p.m. Central Standard Time
- Assists Sr. VP of Integrated Services and VP of Managed Care Programs with projects, presentations, any meeting coordination or tasks upon request
Responsible for MSC Coordinators responsibilities when they are out of the office
- Other tasks as deemed necessary
- This position reports to the VP of Managed Care Programs or MSA Supervisor.
- High School Diploma required. College preferred
- Five years experience in a professional office setting. Experience in managed care, healthcare, worker's compensation or insurance industry preferred.
- Medical terminology
- Strong comprehension and analytical skills
- Strong communication skills
- Team worker
- Research and investigation
- Medical Terminology
- Diagnosis and procedure familiarity
- Medicare Secondary Payer Compliance