Overview

Advanced Medical Support Assistant – Call Center (Contractor) Job at CFOL International: Eastern Colorado Health Care System – VISN 19 – 1.0 in Denver, CO

Job Description



FUNCTIONAL STATEMENT
Office of Community Care
Medical Support Assistant

Organization: Eastern Colorado Health Care System, Denver VA Medical Center (554)

Introduction: This position is located in the Office of Community Care (OCC) Section of the Eastern Colorado
Health Care System (ECHCS). The purpose of this position is to provide clerical, administrative and financial management support for the medical services, Community Care contracted services and all other outpatient medical services that fall under the Veterans Medical Benefit Package.

1*. GENERAL DESCRIPTION: *

The Advanced Medical Support Assistant (MSA) is responsible for all Non-VA outpatient specialty clinics electronic consults through Computerized Patient Record System (CPRS); along with processing authorizations through Community Care programs and scheduling Veterans through VISTA/VSE.

The Advanced Medical Support Assistant (MSA) work impacts the administrative aspect of patient care, including access, scheduling/coordinating appointments using advanced clinic access principles, managing the Electronic Wait List (EWL), patient processing and customer service.

The Advanced MSA maintains accuracy, reliability and proficiency in authorizing Community Care consults through CPRS and Community Care programs with proper documentation in an expeditious manner. Consult referral management takes place, the Incumbent initiate’s administrative eligibility, appropriate justification, authorization and cost estimations. Community Care consult referral management includes appointment scheduling, tracking, pre- and post- appointments contacts.

It is required the Advanced MSA keeps close communication with the OCC Nurses, Chief of OCC, Payment
Operations & Management (POM) and all VA staff members. The Advance MSA corresponds with Veterans and Community Care providers in processing coordination of care between the facilities of VA Medical Center and Community providers.

Maintains current Knowledge of Community Care procedures, policies, directives in order to answer VA physicians, Community providers and Veterans questions of Community Care; obtains needed information or decisions on Community Care consults placing supporting documentation of vendor demographics along with documentation of authorization and billing remarks.

Determining the legal entitlement of all outpatients authorized, unauthorized, Mill Bill and contract authorization and payment methodology. For those claims where legal entitlement exists, the clerk will obtain all necessary supporting documentation and prepare for review by supervisory officials.

The primary duties of this position are directly related to patient care and the VA specialty care outpatient clinics. The timely processing of authorizations to assure the Department of Veterans Affairs can acquire and meet the needs for patient medical treatment. The Advance MSA must be able to establish and maintain rapport with health care providers in the community. Accurate information relating to Community Care management patient workloads and expenditures is also necessary for VA fiscal management and revenue programs.

2. FUNCTIONS:

The Advance MSA works collaboratively in an interdisciplinary coordinated care delivery model and performs all specialty settings.

1. Daily review of active/pending/scheduled Community Care consults in CPRS, Third party portal for accuracy and disposition.

2. Maintain effective communication with patient, interdisciplinary team, and outside providers, when necessary to process secure messages with patient and VA staff.

3. Explain to patient and their family members procedures on the phone
4. Participates in huddles or meeting with other interdisciplinary members to manage and plan patient care/flow.
5. Enter appropriate information into patient record
6. Administrative follow-up and problem solving for administrative issues. The Advance MSA plays an integral role in identifying and developing ways to resolve problems with the administrative and clinical staff on access, customer service, patient flow, revenue, and data validation issues.

7. Inform physicians about patients and appointments at other facilities. Educates providers about shared patients (those who receive their care at multiple VAs or those who have care in the community)

8. Coordinates administrative services for veterans, family members, caregivers, and general public, administrative and clinical staff to insure continuity of inpatient and outpatient care.

9. Interprets and applies a complex body of pertinent laws, regulations, directives, and policies that relate to the administration of VA Healthcare Benefits.

10. Generates patient workload reports that have to do with schedules/scheduling for validation and monitors activity to assure consistent and accurate reporting.

11. Guides patients through hospital system, documents complaints, provides follow-up and suggests resolutions to supervisor.

12. The Advance MSA must be able to interpret and communicate requirements of VHA Scheduling
Directives and complete accurate scheduling responsibilities. Schedule appointments and utilize the Electronic Waiting List accurately in a timely manner.

13. Appointments are made with the patient’s input, by phone. This may require a high level of coordination to avoid patients having to make multiple trips to the medical center or clinic whenever possible.

14. The Advance MSA must maintain the ability to perform the varied and complex duties of each of the Program Support Assistants (care facilitators) and the Medical Support Assistants in the Clinical
Support Section.

3. SUPERVISORY CONTROLS:

Work is performed under the general supervision of a Supervisory Medical Support Assistant and is evaluated for appropriateness and conformance to policy. The supervisor will provide direction in terms of objectives, priorities and deadlines.

Employee plans and organizes work with general assistance from the supervisor as to meet local and VA- wide time frames to complete analysis requirements, reports and special assignments. The incumbent is responsible for reporting backlogs, difficulties in meeting deadlines, uncooperative physicians, or difficulty in securing information from clinicians or the record.

Routinely communicates with physicians, case managers, and other allied health professional staff on complex cases using sound interpersonal skills and is constantly aware of the sensitive information. Otherwise, works independently making decisions based on guidelines, precedents and regulations and performs duties in such a manner that only minimal supervision is required. Must be able to use a great deal of independent judgment or interpretation in making decisions. Referrals and questions to the supervisor are infrequent and only for high technical problems or clarification of policies and situations which do not have clear precedents, or which require extensive analysis and evaluation.

Work is reviewed by the lead or supervisor for the purpose of appropriateness and compliance with VHA,
VBA, and HAS policies and procedures. Incumbent’s supervisor sets priorities but allows the employee to organize recurring activities. Completed assignments are evaluated for technical soundness, usefulness, and conformance with VA requirements. Supervision is generally limited to review of overall results on daily scheduling reports, insurance data capture, and standards of performance as well as feedback from the clinic team to ensure mission is carried out.

Demonstrated Knowledge, Skills, and Abilities. Candidates must demonstrate the KSAs below:

1. Ability to collaborate, communicate, set priorities, and organize the work in order to meet deadlines, ensuring compliance with established processes, policies, and regulations

2. Ability to communicate tactfully and effectively, both orally and in writing, in order to meet program objectives. This may include preparing reports in various formats and presenting data to various organizational levels.

3. Advance knowledge of the technical health care process as it relates to access to care
4. Advance knowledge of managing a clinic. This includes independently utilizing reference sources, decision making, and empowering the team to collaborate and resolve problems within a complex systems environment.

5. Advanced knowledge of policies and procedures associated with operational activities that affect the patient flow, patient care, and the revenue process.

6. Advance knowledge of medical terminology due to the technical nature of language utilized by clinicians.

4. QUALIFICATIONS: See Handbook 5005/53, Part II, Appendix G-45 – Title 38 Hybrid, Medical
Support Assistant Qualification Standards, dated June 7, 2012

5. CUSTOMER SERVICE:

Incumbent has numerous contacts with the Veterans, their representatives and family members, VA staff,
Community Care providers, employees of other agencies in the community and must have a good rapport with other members of his/her profession. Contacts influence the public image of the facility and the agency.
Incumbent meets the needs of all customers while supporting the Medical Center and Service mission.
Consistently communicates and treats customers (patients, visitors, volunteers, and all Medical Center staff) in a courteous, tactful, and respectful manner. Provides the customers with consistent information according to established policies and procedures, handles conflict and problems in dealing with the customer constructively and appropriately.

6. AGE SPECIFIC CRITERIA:

The primary age of Veterans receiving OCC care between the ages of young adult 18-44, Middle Age Adult
45- 65 and Old Adult 65 and over. The position requires the incumbent to possess or develop an understanding of the particular needs of these types of patients. Sensitivity to the special needs of all patients in respect to age, development requirements, and culturally related factors must be consistently achieved.

7. COMPUTER SECURITY:

In the performance of official duties, the incumbent has regular access to electronic files containing sensitive information which must be protected under the provisions of the Health Insurance Portability and Accountability
Act (HIPPA), other applicable laws, federal regulations, and VHA Policies. Incumbent is responsible for: (1)
Protecting information for unauthorized release, loss, alteration, or unauthorized deletion and (2) following applicable regulations, instructions, and security agreements regarding access to computerized files and protection of access codes. The incumbent carries out other duties as requested, provides feedback and input into standard operating procedures and provides training on clinic procedures to new relief staff as necessary.

8. OCCUPATIONAL SAFETY AND HEALTH

Incumbent complies with occupational safety and health regulations, rules and policies.

9. PHYSICAL DEMANDS

The work performed is predominately clerical in nature and requires no special physical standards. The work is usually performed in an office setting, working with others and/or alone. As typical in an office setting, there is the possibility for multiple distractions from normal operating functions and the incumbent is expected to be

able to physically perform the duties of the position, aides permitted (which may include walking, sitting, standing, reaching, and bending.) The work may also include the need for light lifting and carrying (under 15 lbs.) of work materials (i.e.: books, binders, papers, etc.)

Job Types: Full-time, Contract

Pay: $18.50 – $20.00 per hour

Schedule:

Education:

  • High school or equivalent (Required)

Work Location:

Work Remotely:

About the Company

Company: CFOL International: Eastern Colorado Health Care System – VISN 19 – 1.0

Company Location:  Denver, CO

Estimated Salary:

About CFOL International: Eastern Colorado Health Care System - VISN 19 - 1.0