HMO Management Clerk

Hamilton Park Nursing and Rehab•Brooklyn, NY

7d•Onsite

About The Position

The primary role of the HMO Clerk is to assist in gathering clinical documentation and ensuring timely submission of the information to HMOs under the supervision of the MDS Director/Designee. As the HMO Clerk, you are delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. 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.

Requirements

Must possess, at a minimum, a high school diploma or its equivalent
Minimum experience in long-term care dealing with Insurance companies preferred
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
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

Responsibilities

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
Participate in scheduled facility Committee meetings as directed by Supervisor
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
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
Adhere to and implement all facility safety and infection control policies
Maintain residentsâ€™ confidentiality; treat residents with kindness, dignity and respect.
Know and comply with Residentâ€™s Rights rules