Overview

POSITION SUMMARY:

Under the general supervision of the Clinical Manager or designee, this position provides direct administrative support and services necessary for the completion of professional medical responsibilities and functions for DES’ skilled professional medical personnel (SPMP), i.e. DES Physician and Psychologist Advisors, Disability and Appeals Reviewers, Program Managers and the Clinical Manager. The Disability Assistant makes complex decisions regarding protected healthcare information, based on the Federal Health Information Portability and Accountability Act of 1996 (HIPAA). This position is responsible for exercising judgment on all administrative and clerical aspects of the case in conjunction with and at the direction of DES SPMP. The Disability Assistant is a primary customer service interface for DES’ SPMP with clients and external agencies.

Responsibilities

MAJOR RESPONSIBILITIES:

• Initial review of all disability supplements for accuracy, completeness, and alerting SPMP of priority cases and of important clinical information contained in cases.
• Make complex decisions regarding privacy matters associated with the client’s case, including determination of who DES may exchange information with regarding the client’s case, what information may be mailed, and what is required, by HIPAA, to allow conversations to take place. These decisions are conveyed to SPMP through detailed case notes and individual consultation.
• Follow HIPAA regulations for protected healthcare information, requests clinical information from all treating sources listed on case initiation documents.
• Determine if requests for information are legally complete, communicate with agencies about cases that do not meet HIPAA requirements for protected healthcare information and consult with SPMP about decisions regarding whether to return to cases to the agencies or clients for further development.
• Telephone contact with clinical treating sources to assure timely receipt of clinical information at the request and direction of SPMP.
• Review information in external databases such as the Massachusetts Medicaid Information System and MassHealth MA21databases in order to identify cases that SPMP could complete quickly.
• Complete initial distribution of new cases to appropriate staff under the direction of and using criteria developed by SPMP.
• Receive and process returned mail, judge its impact on the case, and work closely with SPMP on follow up action.
• Coordinate transportation of clients to consultative examinations and provide feedback to SPMP on unusual circumstances that would impact the review process.
• Provide both incoming and outgoing telephonic customer service and support functions.
• Make decisions for rescheduling of clients’ clinical evaluations, based upon agency guidelines and provides input and feedback to SPMP.
• Perform other duties as required.

Qualifications

REQUIRED QUALIFICATIONS:

• Associate’s degree in business or a related field, or equivalent
• 3-5 years of office experience, preferably in a medical setting
• Knowledge of HIPAA laws and regulations
• Proficient in Word, Access, Excel and Outlook
• The ability to interpret complex HIPAA regulations for clients, and agencies
• Strong phone customer service and problem solving abilities in order to educate clients and other external customers about the disability review process
• Ability to handle confidential information with discretion.