This position extracts pertinent clinical findings from physician notes and completes data entry into the InCircle algorithm. The position also completes process documentation and assists in training additional employees as part of the onboarding process.
The incumbent will also work with MD to assist with the algorithm reviews for clients and also be a liaison as needed to facilitate data requests.
Enters beneficiary demographic data into the InCircle application
Reviews clinical records submitted and extracts pertinent clinical findings from the record.
Enters pertinent clinical findings into the InCircle algorithm.
Tracks status of Physician Reviews for timely completion
Follows up with Physician Reviewers as non-completed reviews near deadlines
Works with InCircle development team to improve data extraction and data entry process.
Completes process documentation for future staff training.
Assists with training of newly hired data extraction specialists
Attend company and departmental meetings as requested.
Assist Management team with other duties as needed.
Continuously strive to improve processes, service quality to internal and external customers.
Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.
Display dedication to the position responsibilities and achieve assigned goals and objectives.
Ensure conduct is consistent with all Compliance Program Policies and Procedures when engaging in any activity on behalf of the Company; immediately report any concerns or violations.
Other duties as assigned
KNOWLEDGE, SKILLS AND ABILITIES:
Experience in handling Prior Authorizations Experience with medical terminology.
Excellent computer skills.
Excellent verbal and written communication skills and the ability to interact effectively with customers, co-workers, and management.
Strong organizational skills including the ability to organize data and concepts into effective processes.
Ability to perform work with a high degree of accuracy.
Ability to prioritize and track multiple projects to ensure deadlines are met.
Ability to participate on and work as an integral member of a team.
Ability to exercise discretion and maintain confidentiality to the level of required HIPAA standards.
Ability, flexibility, and desire to work overtime as needed for special project completion.
Ability to work and make decisions independently and effectively with limited supervision and direction.
Ability to respond to and recommend solutions to a wide variety of problems.
Intermediate to advanced knowledge/skill level of Microsoft Outlook, Word, and Excel.
Basic understanding of Internet technologies.
Represent the Company in a professional manner and appearance at all times.
Understand and internalize the Company’s purpose, Display loyalty to the Company and its organizational values.
Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and; respect the diversity of our work force in actions, words, and deeds.
EDUCATION AND EXPERIENCE DESIRED:
Bachelor's degree in healthcare field preferred.
Successful completion of Medical Assistant training program an asset.
Expertise in Prior authorization process either n a medical clinic or specialty pharmacy setting a huge plus
Prior experience in neurology or immunology
Typical Office Environment:
No unusual exposures
Operate office equipment
While performing the duties of this position, the employee is required to regularly use hands to finger, handle or feel objects, tools, controls and equipment. The employee must be able to walk, sit and stand. The employee occasionally lifts up to 20 lbs. and occasionally kneels and bends.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions of this position. Work overtime and on weekends on occasion.
FFF Enterprises is an EEO/AAP employer; all business decisions (employment, promotions, compensation, etc.) are made without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, gender identity, or any other legally protected status.
About FFF Enterprises, Inc and Nufactor Specialty Pharmacy
FFF Enterprises is the nations must trusted specialty distributor of plasma products, vaccines, biosimilars, and other specialty biopharmaceuticals and pharmaceuticals. Our partners include the largest and most influential GPO’s, servicing over 80% of United States hospitals and supplying the nations leading non-acute care sites. Our unprecedented programs unite manufacturers, GPO’s and hospital partners, resulting in cost-containment and more access to common and uncommon products.
Nufactor is the specialty pharmacy subsidiary of FFF Enterprises. It is dedicated to the chronic illness community, providing specialty products, in home infusions, and individualize patient care on a daily basis. Some of the services include 24/7 on call pharmacists, 24/7 on call infusion experts, Nursing services, patient and physician educational programs, patient advocates, and administrative services.