- Bachelor's degree and three years of related experience; or an equivalent combination of education and related work experience.
- Excellent written and verbal communication skills.
- Working knowledge of the techniques used to present statistical data.
- Effective analytical skills to evaluate data reliability, determine appropriate statistical models, correlate factors, and organize data.
- Project management/related experience and skills.
- Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
- Experience with EMR systems and demonstrated ability to extract medical records.
- Project Management and Administration
- Provides leadership to project to assure inclusion of data analysis, reporting capabilities and overall project scope is intact.
- Utilize project management techniques to research, document and coordinate activities to ensure deliverables are met.
- Perform network analysis that supports business operations and project management. Assist to define solutions that support business flows through use of workflow design/redesign.
- Monitor, evaluate, interpret, and disseminate program requirements related to risk. Ensure activities are conducted in accordance with applicable standards, line of business controls and requirements. Develop methods to improve daily operations and practice standards.
- Collaborates with external customers and clients (primarily key providers) to evaluate business needs.
- Escalate retrieval risks based on provider interactions appropriately.
- Problem solves solutions when barriers prevent provider compliance.
- Applications and Data Analysis
- Learn, acclimate, and engage in successful use of the providers EMR/EHR records system when applicable.
- Retrieve, download, and categorize patient records according to business needs.
- Communicate to providers scope of chart needs, deadline, available options for records submission, etc.
- Maintain accurate and detailed record of all engagement/interactions and attempts to contact providers in support of records request.
- Be able to audit against documentation and adapt format to best suit business needs.
- Ensure all provider communications are secure and records follow privacy guidelines.
- Relationship Management
- Develops, maintains, and nurtures strategic relationships with HMSA's network of health care providers and groups to successfully coordinate, retrieve and collect medical records for HMSA's Government Programs.
- Manages the day-to-day tactical objectives and tight timelines associated with ensuring 100% record retrieval accuracy.
- Problem solves any provider barriers which may prohibit compliance.
- Ensures clear communication w/providers and stakeholders on a daily basis.
- Reports and Presentations
- Produces written progress reports in a structured and informative manner.
- Ensure annotations are accurate, concise, clearly stated, and appropriate for internal audiences to understand.
- Collaborates with external customers and clients (primarily physicians and clinic administrators) to evaluate business needs.
- Network Management Representative
- Function as a Network Management Representative outside of the chart retrieval project timeline and/or based on availability in order to supplement network needs of Provider Operations.
- Other Duties/Functions
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
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Network Management Specialist - Honolulu, United States - Hawaii Medical Service Association
Description
Job Summary**Hybrid Work Environment - Must reside on Oahu **
Pay Range: $57,629 - $88,159
Note: Individuals typically begin between the minimum to middle of the pay range
The purpose of this position is to support HMSA by developing strategic relationships with our network of health care providers and groups to successfully coordinate, retrieve and collect medical records for HMSA's Government Programs. Requires daily interaction with providers in-person and/or by other communication channels such as phone, email, fax, electronic medical record portals, Webex, etc. Inform, collaborate, and contribute to building records retrieval protocols and workflows that are essential to HMSA's future success. Effectively manage, coordinate, and articulate these requests in support of this critical initiative. Serve as a subject matter expert on the performance management functions of HMSA's Government Program plans with relation to medical records retrieval strategies, efforts, workflows, and best practices. Ensure that all chart requests are organized, disseminated, and retrieved within specified timelines. Learn, acclimate and engage in successful use of the providers EMR/EHR records system to develop record retrieval may be completed independently via self-service. Develop a records retrieval strategy that can be easily duplicated and adapted as network needs change.
Direct responsibility for ensuring provider compliance with medical record retrieval requests and developing key provider contacts with key partners at health systems, medical groups/practices, and all other allied health providers so that this process eventually becomes BAU. Manage any requests for reimbursements effectively, using business guidance and escalation protocols to inform decisions. Will function as a core part of the project team in partnership with Government Programs to project manage and administer any needed data analysis. Function as a Network Management Representative outside of the chart retrieval project timeline and/or based on availability in order to supplement network needs of Provider Operations.
Minimum Qualifications
