Address
Form of workKDS
Job ID 2325146
Koniag Data Solutions, a Koniag Government Services company, is seeking an RM/ROFR Healthcare Coordinator to support KDS and our government customer in Bethesda, MD.
We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, flexible spending accounts, paid holidays, three weeks paid time off, and more.
Coordinate receiving and processing all Referral/ROFR (Right of First Refusal) requests.
Essential Functions, Responsibilities & Duties may include, but are not limited to:
- Recommend new ways to improve the Referral Management/ROFR/Health Care Coordinator process. Implement approved methods.
- Review all details of referral/ROFR for suitability, administrative and clinical completeness, and identify required tests, labs, radiology studies and other pre-requisites specific to each assigned product line prior to dispositioning using MHS Genesis (Power Chart and Revenue Cycle), Essentris, and other EHR’s or databases as needed.
- Verify patients are registered in MHS Genesis (Power Chart and Revenue Cycle), and DEERS information and update demographic information as needed.
- Coordinate the implementation process for receiving and processing all ROFR requests from Humana.
- Provide recommendations and monitor process to ensure staff adheres to the defined timelines for response (2 days response for routine/ 90 minutes for urgent).
- Coordinate process for research and communicate with requesting providers, Humana and others as needed to ensure complete medical information is available to make informed decisions about a ROFR matter.
- Enter or copy referrals/ROFR in MHS Genesis (Power Chart) according to MHS/IRMAC standard operating procedures.
- Coordinate and monitor process for ROFRs between MTF’s using established system for ROFR distribution.
- Identify ways to improve job efficiency and make appropriate suggestions to improve the ROFR process.
- Provide recommendations and/or assistance to other ROFR staff when advising all categories of patients of what their referral and access to care options are as related to their eligibility and beneficiary status.
- Coordinate process for appointing and tracking consult results for ROFR Search all MTFs for possible ROFR acceptance, based on clinic guidance and available appointments within the MHS Genesis (Power Chart and Revenue Cycle).
- Prepare and consolidate monthly reports as requested.
- Maintain the MTF Specialty Capability Table for assigned specialty clinics.
- Complete and return all CLR (clear and legible reports) to the ordering civilian provider within the required timelines (for routine, 7 days and for urgent, 3 days from date of appointment).
- Search all MTFs for possible ROFR acceptance, based on clinic guidance and available appointments within the MHS Genesis (Power Chart and Revenue Cycle)
- Schedule patients in MHS Genesis (Revenue Cycle) for appointments at any MTF in the National Capital Region eMSM based upon ROFR appointing guidance and capacity.
- Verify patients are registered in MHS Genesis (Power Chart and Revenue Cycle).
- If patient isn’t registered, ROFR staff will contact Patient Administration to have patient registered in MHS Genesis (Power Chart and Revenue Cycle), based on Defense Enrollment Eligibility Reporting System (DEERS) information and update patient demographic information as necessary.
- Assist with other duties within the Referral Management Office related to the processing referrals to Direct Care MTFs and Civilian Care per IRMAC responsibilities.
- Prepare, review, and report data to demonstrate understanding of the ROFR Process as required.
- Provide follow up with MTF provider to complete and sign the associated encounter for their referral.
- Review monthly reports on ROFR data with data analysts.
- Identify and resolve ROFR issues in accordance with NCR Business Rules as necessary.
- Ensure equitable distribution of ROFR workload between MTFs and among the NCA ROFR staff as required.
- Prepare and report data to demonstrate understanding of the ROFR Process as required.
- Educate NCR providers/patients on the ROFR Process as needed.
- Document and update all ROFR cases in the Integrated Referral Management and Appointing Center (IRMAC) database.
- Process all ROFR cases in the interest of optimizing care in the MTFs as needed.
- Maintain effective communication with appropriate staff and work closely with technical staff to ensure efficient operation.
- On occasion, can take on Team Lead responsibilities as requested by the Referral Management Team Lead.
- Review referral information in the IRMAC Pro-Active Calling Database.
- Determine whether patient and appointment type meet clinic specified in referral appointment protocols.
- If a patient meets appointing protocols, check clinic schedule for appointment availability.
- Document the referral in MHS Genesis (Power Chart and Revenue Cycle) and in the IRMAC Pro-Active Calling Database.
- If an appointment is available, contact the patient.
- If the patient refuses the appointment, the Agent will document the MHS Genesis (Power Chart and Revenue Cycle) and the IRMAC database and explain to the patient that the referral will be sent back to the enrollment MTF for further review/action.
- If the patient accepts the appointment, the Agent will document the MHS Genesis (Power Chart and Revenue Cycle) and IRMAC database.
- Priority of work should be: 1) referrals appearing in the “Yesterday”’ box of the IRMAC database.
- 2) referrals residing in the 2nd attempt box, and 3) referrals sitting in the 3rd attempt box.
- Perform administrative duties that support referral/ROFR/Health Care Coordination and appointment management and Product Line Nurses/Team under the supervision of either Referral Management or Appointing supervisors.
- Prepare, consolidate, analyze, and brief reports as directed in consultation with data analysts as needed.
- Travel and attend meetings/conferences/briefs as requested.
Work Experience, Knowledge, Skills & Abilities:
- Associate degree or minimum three years’ experience in medical environment
- 6 months’ experience working in a medical environment, customer, or member service call center preferably with emphasis on appointment scheduling.
- Experience using Composite Health Care System (CHCS)
- Thorough knowledge of the Military Health Care System, TRICARE, medical terminology, release of medical information and medical and legal ethics.
- Superior customer service skills
- Accurate data entry skills
- Highly organized and detail oriented
- Strong verbal and written communication skills and sound judgement
- Ability to read, write, speak, and understand English.
- Must be a U.S. Citizen
- Right of first refusal for employment will be given to current workers in accordance with EO 13495.
Working Environment & Conditions
This job operates in a professional office environment and has a noise level of mostly low to moderate. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
This position is primarily indoors, consistent with a standard office position and has a noise level of mostly low to moderate. The incumbent is required to stand, walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; talk and hear. The workload may require the incumbent to sit for extended periods of time. The incumbent must be able to read, do simple math calculations and withstand moderate amounts of stress.
The incumbent must occasionally lift and/or move up to 25 lbs. Specific vision abilities required by the job include close vision, distance vision, color vision, depth perception, and the ability to adjust focus.
Our Equal Employment Opportunity Policy
The company is an equal opportunity employer. The company shall not discriminate against any employee or applicant because of race, color, religion, creed, sex, sexual orientation, gender, or gender identity (except where gender is a bona fide occupational qualification), national origin, age, disability, military/veteran status, marital status, genetic information, or any other factor protected by law. We are committed to equal employment opportunity in all decisions related to employment, promotion, wages, benefits and all other privileges, terms, and conditions of employment.
The company is dedicated to seeking all qualified applicants. If you require accommodation to navigate or to apply for a position on our website, please contact Heaven Wood via e-mail ataccommodations@koniag-gs.com or by calling 703-488-9377 to request accommodation.
Koniag Government Services (KGS) is an Alaska Native Owned corporation supporting the values and traditions of our native communities through an agile employee and corporate culture that delivers Enterprise Solutions, Professional Services and Operational Management to Federal Government Agencies. As a wholly owned subsidiary of Koniag, we apply our proven commercial solutions to a deep knowledge of Defense and Civilian missions to provide forward leaning technical, professional, and operational solutions. KGS enables successful mission outcomes for our customers through solution-oriented business partnerships and a commitment to exceptional service delivery. We ensure long-term success with a continuous improvement approach while balancing the collective interests of our customers, employees, and native communities. For more information, please visit www.koniag-gs.com.
Equal Opportunity Employer/Veterans/Disabled. Shareholder Preference in accordance with Public Law 88-352
