Our Vision is to provide unique, innovative and value-added healthcare management solutions, by affording cost-effective, high quality and comprehensive administrative services so our clients may focus, above all, on patient care.
Physicians DataTrust deploys exceptional management services to support Independent Physician Associations (IPAs) with both commercial and senior managed care (HMO) members. Our unique administrative infrastructure is built on more than 100 years of collective experience in the managed care industry, cutting edge technology, and tenured staff to provide personalized care and exceptional service. Our best business practices and proven approach to managed care ensures compliance, integrity and success for independent physicians in the complex business environment of health care.
When looking for your next Management Service Organization, choose Physicians DataTrust, your best partner for growth. We are the "US" in Trust!
Primary Purpose:
To provide general support to the IS Department, ensure accurate and timely data entry into the primary processing system, and provide Level 1 on-site and remote IT support, including support for the Aerial Care Coordination application.
Principal Duties and Responsibilities (* = essential functions):
* Responsible for manually adding and updating membership data in MedMC & EZ CAP. *
* Responsible for monitoring and work requests received via the Aerial Care Eligibility Task list for each IPA daily and Aerial Provider Registration requests at least twice weekly for each IPA *
* Manage the Eligibility email box daily, including handling all email and faxed eligibility inquiry and update requests. *
* Oversee the ECR (Electronic Claim Retrieval) process, including retrieving files, loading files to MedMC, working and researching issues, and all related tracking and reporting. *
* Assist with reviewing and working on monthly Eligibility Edit reports. *
* The specialist will review and correct rejected or mismatched claims in the EZ-Net portal to ensure accurate data formatting before final adjudication.
* Work and respond to internal and Health Plan out-of-pocket requests, updating the primary processing system accurately.
* Assist in monitoring IT tickets submitted by PDT staff to ensure efficient, complete responses. *
* Act as Level 1 Onsite and remote IT Technical support to PDT staff. *
* Manage and track all PDT IT Equipment *
* Provide individual and group user training related to IT & IS supported software and hardware *
* Accurately interpret and apply departmental policies and procedures using sound judgment.
* Assist with the troubleshooting of issues and testing of updates
* Provide cross coverage and support to other IS staff.
* Other duties as assigned.
Job Specifications (KSAs):
* Strong attention to detail and accurate, efficient data entry.
* Ability to read and understand health plan eligibility and benefit information and Division of Financial Responsibility matrices.
* Requires familiarity with medical terms, practices, and coding (CPT, HCPCS, ICD9/10, Revenue, etc.)
* Working knowledge of all Microsoft Office applications, including Excel and Access.
* High level of professionalism with good interpersonal and communication skills.
* Able to work independently on a variety of tasks and in a team setting.
* Ability to prioritize and perform a variety of complex tasks.
* Requires the ability to speak, read, write, and understand English and other general educational skills as is generally obtained by completing high school or a GED
Position Performance Criteria:
1. Consistently produces quality and quantity of work related to departmental standards, accuracy measures, and goals promptly.
2. Demonstrates high reliability through consistent punctuality and attendance.
3. Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow-through.
4. Uses sound judgment in time management and prioritizing work to balance multiple tasks and meet required timeframes for all activities.
5. Demonstrates excellent interpersonal skills as discerned through observation and team project success.
6. Accurately interprets and applies departmental policies and procedures using sound judgment.
7. Communicates professionally and respectfully to peers, superiors, subordinates, and clients.
8. Follows through on tasks and provides constructive feedback on assigned work projects.
9. Demonstrates overall professionalism in attitude, demeanor, and personal appearance
