Provider Management Coordinator

Provider Management Coordinator

Under the general supervision of the Operations and Training Specialist or designee, this position is responsible for coordinating client appointments for Consultative Examinations (CE) by medical and psychiatric providers within the Commonwealth of Massachusetts. This position performs complex and varied duties associated with the coordination of departmental administrative functions through the use of the DEScovery computer system as well as Word, Excel, Access and Outlook applications. The Provider Management Coordinator is the primary contact for the community-based DES provider network, interfacing between disability reviewers requesting examinations and the CE network provider performing examinations. This position makes complex decisions regarding protected healthcare information (PHI) based on the Federal regulations regarding the protection of health information under the Health Information Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.

In addition, this position conducts business across all departments within DES. The Provider Management Coordinator is responsible for all functions involving providers for the DES CE provider panel, comprised of approximately 150 clinicians located throughout the Commonwealth of Massachusetts. Decisions made in this area directly impact the timeline for the disability review process and for the determination of benefits for MassHealth and other agency applicants. This position is the primary hub for all coordination of medical and psychiatric examinations, and interacts with clients, providers, and DES staff regarding establishing client appointments.

Responsibilities

Major responsibilities include :

• Serving as a liaison between our providers and DES staff.
• Coordinating the complex scheduling of medical, psychiatric and learning disability examinations for clients applying for MassHealth, Department of Transitional Assistance or State Supplement Program disability benefits.
• Reviewing requests for appointments to ensure that an appropriate provider is chosen based on specialty of the exam, the geographical location of the client, the provider's availability and the client's preference.
• Reviewing and editing CPT codes assigned to ancillary tests to ensure accuracy and consistency within the DES guidelines and provider capabilities.
• Critically assessing DTA clients from the pool of CE exam requests to determine who might benefit from their appointment being arranged at a local DTA office. Qualifying clients will be contacted by a phone call and / or letter to arrange these CE exams. Coordinates these appointments closely with the CE provider and the appropriate DTA office.
• Maintaining statistics on client participation and making recommendations for improvement.
• Collaborating with CE providers to triage problems related to client's exams, involving other DES staff, as needed, to assist in problem resolutions.
• Forecasting and identifying opportunities for multiple appointments with the same provider to achieve potential cost savings with a block sequence arrangement with interpreter service vendors.
• Making complex decisions regarding privacy matters associated with the client's case, including determination of who DES may exchange information with regarding the client's case, what information may be mailed, and what is required, by HIPAA, to allow conversations to take place.
• Corresponding and communicating daily with advocates and agencies handling sensitive and confidential records / information for clients at DES. Communicates confidential information via phones & secure email, assuring there is always adequate coverage.
• Entering appointment information into DEScovery or MedQuest system in a timely manner. Also enters scheduling data into other databases such as Learning Disabilities and State Supplement Program. Responsible for alerting disability reviewers of incoming CE reports for any DES program.
• Generating reports in preparation for analysis and graphical display. Organizing information into spreadsheet format for data collections.
• Reviewing provider finances monthly & resolving financial accounting questions with providers. Coordinating inbound calls from clients, providers and agencies in an expert manner with excellent communication & organizational skills and telephone etiquette & resolving any issues they might have.
• Collaborating with multiple interpreter services by requesting and / or cancelling interpreters for clients and entering the information on an excel spreadsheet. Ensuring that electronic data transmission of daily interpreter is performed in a secure manner, according to DES & ForHealth Consulting data security policies and procedures.
• Providing directions to clients for CE appointments, and helpful office descriptions for their appointments. Overnight and express mail client letters / provider letters, English and / or Spanish.
• Complying with established policies, health & safety regulations and requirements, procedures and department objectives.
• Performing scanning functions, faxing, scanning of daily provider schedules, invoices for providers, client letter, letter to providers, dictations to sign and other documents on a daily basis.
• Monitoring & evaluating office procedures and identifying areas for improvement. Initiating & implementing new procedures as needed.
• Performing other duties as assigned.

Qualifications

Required qualifications include :

Preferred qualifications include :