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Beth Israel Lahey Health · 4 hours ago

Hybrid Administrative Performance Improvement Program Assistant, 24hr - Days

Winchester, MA

Full-time

Hybrid

Entry Level

$20/hr - $30/hr

3+ years exp

Beth Israel Lahey Health is a growing healthcare organization committed to making a difference in people's lives. The Hybrid Administrative Performance Improvement Program Assistant will support various clinical program projects, manage referral processes, and maintain the Highland Management referral database under the direction of the Performance Improvement Coordinator.

Elder CareHealth CareHospitalPrimary and Urgent CareProfessional ServicesTraining

Responsibilities

Responsible for all aspects of processing out-of-IPA referrals

Verifies completeness of Out-of-IPA referral forms received via fax, IPA website, or US mail, contacting Primary Care Physician office staff, if necessary, for additional information or to clarify information

Communicates any educational opportunities that are identified to the Highland Management Provider Relations Specialist

Researches patient information via internet and Epic such as health plan eligibility, PCP verification, prior referral history, etc

Researches physician information such as health plan contract affiliation, NPI number, hospital affiliation, address, etc

Responds to phone calls from IPA physicians (PCPs & Specialists) and physician office staff with referral questions requiring research, problem solving, and follow-up. Communicates new information to colleagues as needed

Provides education and support to IPA physicians and physician office staff as it relates to the Out-of-IPA Referral Program

Promotes and encourages in-IPA specialists and Winchester Hospital services through office staff education and assistance with appointment scheduling, as necessary

Collaborates with Performance Improvement Coordinator, IPA Provider Relations Manager, and Health Plan Provider Relations for assistance with referral questions, as necessary

Acts as Liaison between Tufts out-of-network physician reviewer and PCP practice for Tufts out-of-network referrals received

Contacts Tufts website staff for assistance as needed

Faxes ‘disagree’ notification to Primary Care Physician offices, where applicable. Follows-up on ‘disagree’ referrals with Primary Care Physician offices for final status

Completes and processes referral authorization requests (via internet or paper referral form) received from Primary Care Physician offices

Evaluates and assigns Referral Code(s) to each referral

Maintains organized, accessible files on referral authorization requests and finalized referrals for cross-reference and documentation

Data enters all out-of-IPA referral information into the Highland Management referral database

Prepares patient referral packets for mailing to out-of-IPA specialist

Maintains supply of all forms necessary to facilitate referral processing

Generates and quality control checks monthly Out-of-IPA Referral Submission report for Performance Improvement Coordinator review, updating the Highland Management referral database, as needed

Responsible for mailing quarterly Out-of-IPA Referral Submission Report to each PCP

Responsible for maintenance of Highland Management Referral database; updating database with new and terminated PCPs, quality control checks database for consistent and accurate data

Identifies enhancement opportunities for referral database and responsible for lead role between Hospital Information Systems personnel to accomplish enhancement goal(s)

Completes Out-of-IPA Admission tracking form for each out-of-IPA admission from the Health Plan census reports and Tufts Medical Center Admission Notification report. Completes and faxes the admission notification form to the Primary Care Physician

Responsible for Highland Management clinical program projects including but not limited to: Researching and obtaining patient lab & radiology results in Epic and preparing reports for distribution to physicians

Researching and obtaining information in physician reports from the IPA reporting consultant-ManagedCare.com and preparing reports for distribution to physicians

Updating Physician Performance Profile Report results for physician performance measures

HPHC HIT Survey Project

Coordinates and organizes complex mailings to IPA physicians, practice managers, nurse practitioners, and physician assistants, including reminder mailings and faxes as applicable

Preparing meeting presentation packets

Responsible for updating and quality control check of MHQP website database with physician and practice manager information. Liaison to MHQP staff

Responsible for updating BCBSMA Physician Reconciliation Report as needed

Maintains appropriate internal and external confidentiality to ensure compliance with HIPAA and other regulatory requirements

Participates In The Following: Mandatory training requirements as per hospital/unit policies, Continuing education/in-services to enhance knowledge, Staff meetings, Performance improvement initiatives, HM/IPA website team, Orientation of new staff, students, and/or volunteers

Qualification

Healthcare experienceMicrosoft Office proficiencyEpic experienceMedical Terminology knowledgeOrganizational skillsCustomer service skillsAccess experienceLearn softwareInterpersonal skillsOral communication skills