What are the responsibilities and job description for the Clinical Administrative Assistant - UM position at Upper Peninsula Health Plan?
POSITION: Clinical Administrative Assistant-UM
DEPARTMENT: Clinical Services (CS)-UM
BASE RATE: $16.37 per hour, with potential for additional compensation based on qualifications.
POSITION SUMMARY:
This position provides primary administrative support to the Clinical Services Utilization Management (UM) Department to ensure efficient operation of the department.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
2. Answers phone calls and addresses non-clinical inquiries such as member eligibility and prior authorization status. Transfers clinical related questions to the Clinical Coordinator-UM. Documents specific member inquiries in Plexis Claims Manager (PCM) system.
3. Manages incoming UM faxes by renaming files with member name, product line, and if request is urgent. Notifies requesting providers on members who are no longer on UPHP, identifies duplicate requests, faxes providers requesting clinical when no information is sent with request, and attaches clinical to requests as needed.
4. Quality assures denial letters utilizing UM denial letter checklist.
5. Collaborates with MDHHS on disenrollment activities and reports, submits disenrollment paperwork for UPHP Medicaid, HMP, MME, CSHCS members requiring more than a 45 day stay in skilled nursing facility and completes script in Altruista.
6. Monitors UPHP Assist Portal for member needs, flagging any special needs populations (high dollar, transplant, Benefits Monitoring Program, Transition of Care), and communicates to Clinical Coordinator - UM.
7. Generates and prepares UM mailings twice a day; delivers mail to USPS drop box as scheduled or as needed to meet UM timeframes.
8. Assists with authorization data entry into PCM.
9. Enters skilled nursing, inpatient, and observation admission, updates, and discharge notification data entry into PCM.
10. Completes meeting minutes from UM meetings.
11. Participates in departmental and interdepartmental process improvement; recommends improvements in processes as opportunities are identified.
12. Demonstrates general knowledge of the required National Committee for Quality Assurance (NCQA) standards that are relative to clinical functions.
13. Maintains confidentiality of client data.
14. Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS:
Education:
Minimum:
High School Diploma
Preferred:
Associate or bachelor’s degree in business, office systems, or related health care field
Experience:
Minimum:
Two (2) years of experience in a medical or general office setting or combination of education
and experience
Preferred:
Five (5) years of experience in a medical or general office setting
Other Requirements:
A valid driver’s license and proof of insurance
Working vehicle
Required Skills:
Excellent written and verbal communication
Excellent organizational and prioritization skills and attention to detail
Keyboarding proficiency
Knowledge of PC applications (MS Word and Excel)
Composition, transcription, and proofreading abilities
Electronic transfer of files/documents; internet proficient
Knowledge of office machines, i.e., fax, copier/scanner
Desirable Skills:
Oriented to managed care or health care systems
Knowledge of medical terminology
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements:
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
Ability to access departmental files
Ability to enter and access information from a computer
Ability to access all areas of the UPHP offices
Occasionally lifts supplies/equipment
Prolonged periods of sitting
Manual dexterity
Working Conditions:
Works in office conditions, but occasional travel may be required
Subject to many interruptions
Occasionally subjected to irregular hours
Salary : $16
