HMO Management Clerk

Job Summary

The primary role of the HMO Clerk is to assistin gathering of clinical documentation and ensuring timely submission of theinformation to HMOs under the supervision of MDS director/Designee.

Delegation of Authority

As the HMO Clerkyou are delegated the administrative authority responsibility andaccountability necessary for carrying out your assigned duties.

Job Functions

Every effort hasbeen made to identify the essential functions of this position. However it inno way states or implies that these are the only duties you will be required toperform. The omission of specific statements of duties does not exclude themfrom the position if the work is similar related or is an essential functionof the position.

Duties and Responsibilities

Administrative Functions

• Assist with submitting beneficiary notices toresidents/family as instructed by the MDS Director/Designee
• Assist in with Audits and ADRs data collection under thesupervision of MDS Director/Designee
• Assist withdaily census and payer reconciliation(Visual vs PCC EMRs)
• Coordinate HMOmanagement process as instructed by the MDS Director
• Complete HMOtracking spread sheet weekly Calendar for due progress reports and clinicalupdates
• Participate/attendsUtilization Review meetings as instructed by the MDS Director/Designee
• Ensureadherence to HIPPA compliance
• Other duties asassigned or as deem necessary and appropriate or as may be directed by the MDSDirector/Designee

Committee Functions

• Participate inscheduled facility Committee meetings as directed by Supervisor

Personnel Functions

• Perform allassigned tasks in accordance with established policies and procedures and asinstructed by your Supervisor
• Follow workassignments and/or work schedules in completing and performing your assignedtasks
• Create andmaintain an atmosphere of warmth personal interest and positive emphasis aswell as a calm environment

Staff Development

• Attend andparticipate in scheduled training and educational classes. Attend andparticipate in scheduled orientation programs and activities
• Attend and participatein annual OSHA and CDC in-service training programs for hazard communicationTB management and bloodborne pathogens standard

Safety and Sanitation

• Adhere to andimplement all facility safety and infection control policies

Resident Rights

• Maintain residentsâ confidentiality; treat residents withkindness dignity and respect. Know and comply with Residentâs Rights rules

Working Conditions

• Works in office area as well as throughout the facility and its premises
• Moves intermittently during working hours
• Subject tofrequent interruptions
• Subject to callback during emergency conditions etc. severe weather evacuationpost-disaster
• May be involvedwith residents family members personnel visitors governmentagencies/personnel etc. under all conditions/circumstances

Education

• Must possess at aminimum a high school diploma or its equivalent

Experience

• Minimum experience in long-term care dealing with Insurancecompanies preferred

Specific Requirements

• Must possess theability to make independent decisions when circumstances warrant such action
• Must possess theability to deal tactfully with personnel residents family members visitorsgovernment agencies/personnel and the general public
• Must possess theability and willingness to work harmoniously with other personnel
• Must havepatience tact a cheerful disposition and enthusiasm
• Mustpossess exceptional communication customer service and interpersonal skills

Physical and Sensory Requirements

(With or Without the Aid of Mechanical Devices)

• Must be able tomove intermittently throughout the workday
• Must be able tospeak and write the English language in an understandable manner
• Must be able tocope with the mental and emotional stress of the position
• Must possesssight/hearing senses or use prosthetics that will enable these senses tofunction adequately so that the requirements of this position can be fully met
• Must functionindependently have flexibility personal integrity and the ability to workeffectively with the residents personnel and support agencies
• Must meet thegeneral health requirements set forth by the policies of this facility whichinclude a medical and physical examination
• Must be able torelate to and work with ill disabled elderly emotionally upset and attimes hostile people within the facility
• May be necessaryto assist in the evacuation of residents during emergency situations

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