Clinical Operational Rightfax Expert - Remote
Remote - USA, United States
The position is 100% remote
Work Hours: Sunday to Thursday, 5 day work week from 8:00 am - 5:00 pm
Responsibilities:
- Electronic logging of documentation and subsequent notification to downstream entities including Utilization Management (UM), Care Management (CM) or other teams. Ensure that the input information is correct and complete, including member/provider information, medical records, and Protected Health Information (PHI).
- Data entry of authorization requests including location of services, medical diagnoses, and service codes; Telephonic outreach to providers or collaboration with UM Management required in some instances to confirm provider request information.
- Telephonic support to the UM team with the process of member and provider notification of both favorable and adverse determinations for authorizations created within the RightFax department.
- Electronic logging of all critical incoming fax documentation to ensure regulatory compliance adherence. These include, but are not limited to, expedited authorization requests, pharmacy requests, skilled nursing facility requests, homecare requests, and any other documentation with stringent regulatory time frames.
- Cross departmental collaboration to investigate and solve operational issues as well as ensure that process design is working appropriately and accurately. Cooperation with UM, CM, Clinical Information Analyst, Regulatory and Compliance, Legal, Claims, Call Center Operations, Enrollment and Billing, and others as needed.
- Development of job aids and training material for the RightFax and HIE teams, as well as peer to Peer education.
- Attend virtual meetings with outside organizations to promote and educate on HIE material and process.
- Point of contact for vendor managers to assist in re-education of Healthfirst providers.
- Additional duties as assigned
Minimum Qualifications:
- Minimum 3 years’ experience in the healthcare field with knowledge of Medical Terminology.
- Ability to execute and reconcile a high volume of data entry.
- Ability to prioritize and follow through on assigned tasks with minimal oversight.
- Administrative or clerical experience on various computer applications.
- Minimum High school diploma or GED.
Preferred Qualifications:
- Associates degree preferred.
- Astute attention to detail, critical thinking skills, and analytical mindset.
- Interpersonal skills.
- Previous experience working with cross-functional teams.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $39,208 - $52,000
All Other Locations (within approved locations): $34,091 - $49,920
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
ApplyJob Profile
100% Remote Collaborative environment Equal opportunity employer Flexible work hours Fully remote Reasonable Accommodation Remote work
Tasks- Collaborate with departments
- Data entry of medical information
- Develop training materials
- Manage authorization requests
- Regulatory compliance logging
- Telephonic support
Analytical Care management Communication Critical thinking Cross-functional Collaboration Data Entry Documentation Management Electronic health information exchange Interpersonal Job aid development Medical terminology Regulatory Compliance Telephonic Outreach
Experience3 years
EducationAssociate's Degree GED High school diploma
TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9