What are the responsibilities and job description for the Medisaw Specialist position at the Chickasaw Nation?
We are currently looking for a Full Time Medisaw Specialist to join our Claims and Contracts Team team located at the Chickasaw Nation Medical Center.
Summary:
Provides administrative and technical support in providing third party health care to eligible beneficiaries.
Responsibilities:
- Procures health services from private providers through written contracts and agreements within established policies and procedures
- Assists medical staff in preparing referrals for submission to Medisaw Review Committee
- Processes Medisaw requests according to determination made by committee
- Prepares high costs cases for submission to the Catastrophic Health Emergency Fund for funding reimbursement
- Provides patients and outside providers information related to Medisaw guidelines, policies and procedures
- Assists in scheduling appointments and travel arrangements for patient if necessary
- Maintains the Medisaw fiscal records for medical and dental funds
- Ensures accurate posting of records and appropriate forms
- Assures that clinical managers are kept informed on Medisaw fund balances, authorizations, and other pertinent information that applies to their program
- Performs preliminary reviews of other available alternate resources to the patient including Medicare, Medicaid, and private insurance carriers, upon receipt of Medisaw referrals and requests
- Refers the more complex requests and referrals to the supervisor
- Provides initial and follow-up assistance for hospital admission in outside hospitals through contract providers
- Notifies Case Manager of potential long-term admissions
- Follows up with those cases involving alternate third-party resources and assists patients in filing claims for medical services, with stewardship
- Approves requests and referrals involving the expenditure of Medisaw Funds, in the absence of the manager
- Communicates with vendor health facilities and providers regarding Medisaw clerical and administrative processing and follow-up
- Provides direct assistance to patients concerning denials of payment for health care services on other matter to Medisaw
- Issues purchase orders and fax, mail or make arrangements for the patients to take to appropriate receiving department prior to receiving care
- Obtains appointment information and paperwork to the patient in a timely manner
- Works with the patient to reschedule any missed appointments
- Develops in final form acknowledgments or appeals, composes draft responses to their correspondence and Medisaw inquiries for signatures of the manager
- Assists in answering the telephone, greeting visitors, maintaining files or records in the absence of the Medisaw clerk and/or in heavy workload periods
- Assists in the receipt and distribution of incoming mail that requires comparing invoices and statements with pending authorizations forms, researches files to determine if patient was referred and financial commitments made
- Types letters, forms, reports, and other written materials in final form with the responsibility for correct spelling, grammar, format, clarity and neatness
- Works with other service units to process referrals for patients that live outside of our coverage area
- Provides first class customer service - courteous and helpful to all internal and external customer types
- Answers questions in a courteous and professional manner
- Greets and engages with a smile
- Determines needs, seeks positive experience and outcomes
- Completes all training and development requirements and participates in continuing education opportunities
- Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
- Maintains general upkeep of work area and maintains a safe environment
- Maintains and promotes professionalism
- Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
- Adheres to Chickasaw Nation dress code standards
- Maintains knowledge of and follows all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
- Performs all other duties as assigned
Competencies:
Essential:
Essential:
- Ability to make sound decisions in accordance with regulations
- Ability to interpret policy and implement changes
- Able to follow instructions, both written and oral
- Able to adhere to all scheduling and attendance requirements
- Honesty, truthfulness, reliability, accountability
- Able to read, understand, apply, and retain knowledge of Chickasaw Nation, departmental, divisional and all other rules, regulations, policies, procedures and guidelines
- Knowledge of general office accounting practices
- Knowledge of general office budgeting practices
- Knowledge of general office purchasing practices
- Knowledge of modern office equipment and practice
- Knowledge of report writing and keeping statistics
- Knowledge in the use of office automation equipment, basic computer skills and typing is necessary
- Establishes professional working relationships as appropriate
- Works well within a team
- Able to verbally communicate in a professional and positive manner with other team members, departments, guests and management
- Writes effective communications with team, departments, guests and management
Skills:
Essential:
Essential:
- Skilled in operating a computer and/or other equipment related to specific role (i.e. automated currency counters, calculator, projector, binding machine, other related office equipment)
Experience:
Nonessential:
Nonessential:
- 3 years directly related experience
Education:
Essential:
Essential:
- High School, GED or Equivalent
Credentials:
Essential:
Essential:
- Pass general background check
Working Conditions:
Essential:
Nonessential:
Essential:
- Works in an office setting
- Sitting up to 100% of shift
- Sometimes bend, kneel, stoop, push, reach
- May be required to be available for Call-Back
- Pass pre-employment drug test
Nonessential:
- Standing up to 25% of shift
- Walking up to 25% of shift