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Healthcare Access Specialist

2 months ago

Shrewsbury, Massachusetts, United States UMass Med School Full time

Healthcare Access Specialist - Hybrid

Overview

Under the general oversight of the Care Coordination Manager, this role is pivotal in orchestrating the medical access services for Justice Health & Equity (JHE). Responsibilities encompass effective communication and collaboration with both clinical and administrative personnel within federal correctional facilities, as well as the management of schedules across various locations. The position entails scheduling medical services provided within the correctional environment, overseeing critical data management, maintaining automated databases, generating reports, and offering education and support regarding security protocols to both staff and clinicians. All tasks are executed in strict adherence to contractual obligations.

This role involves performing a diverse range of complex duties associated with the coordination of medical services for Federal Bureau of Prisons (FBOP) patients, utilizing JHE claims processing software alongside applications such as Teams, Word, Excel, Access, Adobe, EMR, and Outlook. The Healthcare Access Specialist serves as the primary liaison for the community-based provider network, facilitating communication between bureau providers seeking services and the network providers delivering those services. This position requires making informed decisions regarding protected healthcare information (PHI) in compliance with federal regulations, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.



Key Responsibilities

  • Coordinate intricate scheduling of medical services for the Federal Bureau of Prisons (FBOP), ensuring alignment with contractual obligations and security protocols.
  • Work remotely from designated locations, managing all aspects of assigned onsite specialty clinics.
  • Act as the primary contact for JHE's contracted specialty providers, engaging directly with patients to facilitate care coordination during clinics.
  • Prepare comprehensive medical records for onsite specialty clinics, including imaging, test results, and patient histories.
  • Utilize Bureau of Prisons Electronic Medical Record (BEMR) to assess consultation requests and develop inmate patient schedules, collaborating with senior coordinators and clinical leadership.
  • Conduct audits of encounter forms and provider documentation to ensure accuracy, providing ongoing education to providers for thorough claims submission.
  • Maintain proper boundaries in patient interactions, seeking guidance when necessary.
  • Review daily consultation requests from the FBOP primary care team, ensuring accuracy and completeness.
  • Identify and address gaps in service delivery, researching potential alternatives as needed.
  • Serve as the main liaison between FBOP providers and community-based physicians to streamline service scheduling and resolve issues.
  • Facilitate communication regarding the status of referrals to ensure continuity of care.
  • Develop and maintain systems for requesting and retrieving medical records for scheduled appointments and procedures.
  • Ensure appropriate provider selection based on specialty, location, availability, and client preferences.
  • Maintain accurate scheduling for medical services, anticipating variances and collecting timesheets weekly.
  • Oversee referrals, patient appointments, and ER trips within the JHE claims management software, producing utilization reports.
  • Deliver education on FBOP safety and security protocols to community hospital network providers.
  • Make informed decisions regarding privacy matters related to client cases, ensuring compliance with HIPAA regulations.
  • Communicate daily with community providers while handling sensitive client information securely.
  • Ensure timely entry of appointment and scheduling information into the JHE claims management system.
  • Provide critical scheduling and utilization reports to FBOP clients for continuity of care planning.
  • Exhibit excellent communication and organizational skills while addressing clients, providers, and agencies.
  • Comply with established policies and health regulations.
  • Perform administrative tasks such as scanning, faxing, and managing daily provider schedules.
  • Evaluate care coordination procedures, identifying areas for improvement and implementing new processes as needed.
  • Undertake additional duties as assigned.


Qualifications

  • High School Diploma required.
  • 3 to 5 years of relevant experience in a complex office or healthcare setting.
  • Demonstrated understanding of medical terminology.
  • Knowledge of HIPAA regulations regarding PHI confidentiality.
  • Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and Outlook.
  • Ability to manage stressful situations with professionalism.
  • Strong verbal and written communication skills for effective interaction with diverse populations.
  • Attention to detail and ability to prioritize tasks independently.
  • Position contingent upon passing a background check from the Federal Bureau of Prisons.


Preferred Education and Experience

  • Associate's degree or some college coursework in business or healthcare-related fields.
  • Experience in a dynamic, multi-faceted medical environment.
  • Proven ability to organize and prioritize work responsibilities effectively.
  • Familiarity with medical terminology and CPT codes is highly desirable.
  • Excellent interpersonal and communication skills.
  • Understanding of data security procedures related to the confidentiality of protected health information.