HMO Management Clerk

Job Summary

The primary role of the HMO Clerk is to assist in gathering of clinical documentation and ensuring timely submission of the information to HMOs under the supervision of MDS director/Designee.

Delegation of Authority

As the HMO Clerk, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties.

Job Functions

Every effort has been made to identify the essential functions of this position. However, it in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential function of the position.

Duties and Responsibilities

Administrative Functions

• Assist with submitting beneficiary notices to residents/family as instructed by the MDS Director/Designee
• Assist in with Audits and ADRs data collection, under the supervision of MDS Director/Designee
• Assist with daily census and payer reconciliation(Visual vs PCC EMRs)
• Coordinate HMO management process as instructed by the MDS Director
• Complete HMO tracking spread sheet, weekly Calendar for due progress reports and clinical updates
• Participate/attends Utilization Review meetings as instructed by the MDS Director/Designee
• Ensure adherence to HIPPA compliance
• Other duties as assigned or as deem necessary and appropriate, or as may be directed by the MDS Director/Designee

Committee Functions

• Participate in scheduled facility Committee meetings as directed by Supervisor

Personnel Functions

• Perform all assigned tasks in accordance with established policies and procedures, and as instructed by your Supervisor
• Follow work assignments, and/or work schedules in completing and performing your assigned tasks
• Create and maintain an atmosphere of warmth, personal interest and positive emphasis, as well as a calm environment

Staff Development

• Attend and participate in scheduled training and educational classes. Attend and participate in scheduled orientation programs and activities
• Attend and participate in annual OSHA and CDC in-service training programs for hazard communication, TB management, and bloodborne pathogens standard

Safety and Sanitation

• Adhere to and implement all facility safety and infection control policies

Resident Rights

• Maintain residents†confidentiality; treat residents with kindness, dignity and respect. Know and comply with Residentâ€s Rights rules

Working Conditions

• Works in office area as well as throughout the facility and its premises
• Moves intermittently during working hours
• Subject to frequent interruptions
• Subject to call back during emergency conditions, etc. severe weather, evacuation, post-disaster
• May be involved with residents, family members, personnel, visitors, government agencies/personnel, etc., under all conditions/circumstances

Education

• Must possess, at a minimum, a high school diploma or its equivalent

Experience

• Minimum experience in long-term care dealing with Insurance companies preferred

Specific Requirements

• Must possess the ability to make independent decisions when circumstances warrant such action
• Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public
• Must possess the ability and willingness to work harmoniously with other personnel
• Must have patience, tact, a cheerful disposition and enthusiasm
• Must possess exceptional communication, customer service and interpersonal skills

Physical and Sensory Requirements

(With or Without the Aid of Mechanical Devices)

• Must be able to move intermittently throughout the workday
• Must be able to speak and write the English language in an understandable manner
• Must be able to cope with the mental and emotional stress of the position
• Must possess sight/hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met
• Must function independently, have flexibility, personal integrity, and the ability to work effectively with the residents, personnel, and support agencies
• Must meet the general health requirements set forth by the policies of this facility which include a medical and physical examination
• Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and, at times, hostile people within the facility
• May be necessary to assist in the evacuation of residents during emergency situations