MCS Puerto Rico
Inpatient Program Specialist
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General Description Responsible for analyzing information generated from admissions and discharges in the hospitals belonging to the Inpatient Management Program and presenting the results that support the program's logistics. Serves as the main liaison between hospitals and physicians belonging to the Inpatient Management Program, and medical office and/or hospital staff to maintain active and effective communication to obtain information promptly and in compliance with established quality standards.
Essential Functions
Discuss, monitor, and guarantee the new contracting or contract renewal of the physicians belonging to the assigned Inpatient Management Program and make requests to set up and be active in the system promptly and correctly.
Monitor, review, and/or prepare specific reports, as applicable, for each provider to identify trends and areas of opportunity and implement Corrective Action Plans (CAPs) as needed.
Distribute and discuss with each physician in the Inpatient Management Program the results obtained from the different reports with program data, which reflect the quality standards to be evaluated.
Facilitate and promote communication between Inpatient Management Program Physicians and Primary Care Physicians. Attend and solve internal and external client referrals related to physicians to the Inpatient Management Programs.
Train providers on how to access the system, its capabilities, and functionalities so they can submit Discharge Summaries to the Secure Document Loader (SDL) electronically and verify the details of payments received, among other tasks.
Produce a welcome package with report examples, billing instructions, and important program information, among others, for all providers entering the Inpatient Management Program.
Ensure physicians in the different programs are fully aware of the compensation and incentive model, applicable.
Handle inquiries, uncertainties, and concerns of physicians participating in the program.
Establish and comply with the schedule of visits to providers of assigned programs.
Must comply fully and consistently with all company policies and procedures, local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Minimum Qualifications Education and Experience:
Bachelor’s Degree preferred in Business Administration. At least one (1) year of experience in the Healthcare industry, utilization, or financial analysis. At least three (3) years of experience in utilization, financial analysis, and direct contact with physicians in the Healthcare Industry.
Proven experience may be replaced by previously established requirements.
Certifications / Licenses:
Driver's License valid in the Commonwealth of Puerto Rico is required.
Other:
A car in good condition and available to move to different Puerto Rico locations. Proficiency in Excel, Word, and PowerPoint is required.
Languages:
Spanish – Intermediate (comprehensive, writing and verbal). English – Intermediate (comprehensive, writing and verbal).
Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento.
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General Description Responsible for analyzing information generated from admissions and discharges in the hospitals belonging to the Inpatient Management Program and presenting the results that support the program's logistics. Serves as the main liaison between hospitals and physicians belonging to the Inpatient Management Program, and medical office and/or hospital staff to maintain active and effective communication to obtain information promptly and in compliance with established quality standards.
Essential Functions
Discuss, monitor, and guarantee the new contracting or contract renewal of the physicians belonging to the assigned Inpatient Management Program and make requests to set up and be active in the system promptly and correctly.
Monitor, review, and/or prepare specific reports, as applicable, for each provider to identify trends and areas of opportunity and implement Corrective Action Plans (CAPs) as needed.
Distribute and discuss with each physician in the Inpatient Management Program the results obtained from the different reports with program data, which reflect the quality standards to be evaluated.
Facilitate and promote communication between Inpatient Management Program Physicians and Primary Care Physicians. Attend and solve internal and external client referrals related to physicians to the Inpatient Management Programs.
Train providers on how to access the system, its capabilities, and functionalities so they can submit Discharge Summaries to the Secure Document Loader (SDL) electronically and verify the details of payments received, among other tasks.
Produce a welcome package with report examples, billing instructions, and important program information, among others, for all providers entering the Inpatient Management Program.
Ensure physicians in the different programs are fully aware of the compensation and incentive model, applicable.
Handle inquiries, uncertainties, and concerns of physicians participating in the program.
Establish and comply with the schedule of visits to providers of assigned programs.
Must comply fully and consistently with all company policies and procedures, local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Minimum Qualifications Education and Experience:
Bachelor’s Degree preferred in Business Administration. At least one (1) year of experience in the Healthcare industry, utilization, or financial analysis. At least three (3) years of experience in utilization, financial analysis, and direct contact with physicians in the Healthcare Industry.
Proven experience may be replaced by previously established requirements.
Certifications / Licenses:
Driver's License valid in the Commonwealth of Puerto Rico is required.
Other:
A car in good condition and available to move to different Puerto Rico locations. Proficiency in Excel, Word, and PowerPoint is required.
Languages:
Spanish – Intermediate (comprehensive, writing and verbal). English – Intermediate (comprehensive, writing and verbal).
Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento.
#J-18808-Ljbffr