Description

Job Summary for Program Specialist: Synergy Health Partners (SHP) works with hospital administration and physicians to ensure that specialty physician services are available to ED patients by implementing and managing call compensation programs at each client hospital. This position is responsible for identifying and verifying patient eligibility and entering data for SHP programs that have elected to have SHP manage their patient designation functions. In addition, the Program Specialist provides excellent customer service to physicians and physician offices.

Essential Functions for Program Specialist:

• Research HCFA/CMS 1500 forms for payor status eligibility in the SHP program
• Verify unassigned physician to determine eligibility to place of service or other restrictions of the SHP contract
• Acknowledge eligibility through physician designation forms and return to physician via fax
• Enter patient information and CPT codes provided by the physician into the SHP system
• Send coding review summaries to physicians to verify codes entered and date of expected payment
• Generate a list of all patients in the SHP system that have not yet been discharged and enter any discharge dates into the SHP system that should be added
• Monitor any additional hospital restrictions allowing patient conversion to Self-Pay
• Contact physician offices and send fax notices if a physician-submitted patient is or is not eligible for SHP program
• Respond to questions from physicians or physician offices on the designation of SHP patients and general eligibility questions
• Provides operational reports to clients or SHP employees
• Assists in maintaining patient information and data in accordance with HIPAA regulations
• Utilize Support Ticket portal for tracking of external contact from clients/providers/offices
• Perform other duties as may be assigned

Requirements

Competencies for Program Specialist:

• Knowledge of medical billing, HCFA/CMS 1500 and ICD-9 Codes
• Accurately enters information in the data system
• Knowledgeable in computer software applications, Word, and Excel
• Ability to follow-through, assume responsibility, and use good judgment in reasoning and decision-making
• Ability to prioritize tasks and workload
• Communicate effectively and diplomatically with internal and external customers and other SHP personnel both orally and in writing
• Maintains confidentiality and follows all procedures relating to Personal Health Information (PHI)
• Apply strong problem-solving skills to identify unique situations that would require the attention of management
• Maintain a high standard of work even under during deadlines and frequent interruptions, remaining professional, responsive, and cooperative
• Meets deadlines consistently, displaying flexibility and an eagerness to get the job done
• Work with integrity, trust, and commitment, and sets an example for others