The work involves performing clerical duties of a moderately difficult nature relating to hospital quality management at the Erie County Medical Center Corporation. The incumbent performs a variety of advanced clerical tasks, using electronic software applications, to insure the proper maintenance and distribution of hospital utilization records, reports and related documents. The incumbent works under the general supervision of a higher ranking professional, technical and/or clerical employee with considerable leeway for the exercise of independent judgment. Supervision is not a function of this position. Does related work as required.

TYPICAL WORK ACTIVITIES:
Interacts with insurance companies and external review agencies using various communication modes and provides patient information such as medical chart information, discharge status and alternate level of care status;

Types forms, records and other documents relating to patient activities;

Receives insurance coverage notices and related documents and inputs into electronic database and/or electronic medical health record system; distributes insurance coverage information to appropriate parties;

Inputs and maintains information related to patient records and discharge status in various electronic databases and electronic medical records systems and prepares and distributes reports, surveys and/or studies relating to utilization review;

Compiles and submits required paperwork and patient medical information for requesting expedited reviews and discharge appeals with insurance companies and external review agencies;

Develops statistics and patient data for inclusion in records, reports and other documentation from computerized and electronic databases;

Reviews reports and other documents for completeness, accuracy and conformity with established procedures;

Coordinates with Emergency Room staff to ensure medical rights letters are provided to patients upon admission; documents and communicates findings with appropriate staff;

Presents and/or distributes via certified mail to patients and/or caregivers documents related to insurance coverage, discharge status, etc;

Prepares charts for on-site and off-site review, facilitates expedited reviews, processes chart requests timely and promptly;

Interacts with various hospital staff to obtain and/or provide information to update and maintain patient information;

Serves as Utilization Review liaison;

Prepares payroll for processing, indexes and files documents and correspondence, attends related training sessions and seminars; acts as receptionist, takes telephone messages and provides routine information.

FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS: Good knowledge of office terminology, procedures and equipment; good knowledge of hospital and medical terminology; good knowledge of Medicare, Medicaid and private health insurance company guidelines, rules and regulations; good knowledge of guidelines, laws and regulations related to patient privacy and protected health information; working knowledge of hospital organization and the functions of various divisions; working knowledge of medical forms and clerical procedures; ability to understand and carry out complex oral and written instructions; ability to word process from clear copy or rough draft at an average rate of speed; ability to use Microsoft Office applications and various medical electronic software; ability to communicate effective, both orally and in writing; ability to work independently; ability to handle multiple priorities; clerical aptitude; sound judgment; neatness; tact; courtesy; capable of performing the essential functions of the position with or without reasonable accommodation.

MINIMUM QUALIFICATIONS:
A) Graduation from a regionally accredit or New York State registered college or university with an Associate’s Degree; or

B) Graduation from high school or possession of a high school equivalency diploma and two (2) years of hospital clerical experience; or

C) An equivalent combination of training and experience as defined by the limits of (A) and (B).

NOTE: Verifiable part-time and/or volunteer experience will be pro-rated toward meeting full-time experience requirements

Location: Erie County Medical Center · Social Services
Schedule: Full Time - FT, Day Shift, 8-4


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