Job description

JOB PURPOSE:

The Clinical Assessment Team Administrative Assistant will be responsible for scheduling UAS-NY nursing assessments for initial prospects and enrolled PACE participants to ensure compliance with regulations and deadlines set forth by DOH/CMS/PACE and CenterLight. This position will manage day to day UAS-NY operations to help increase efficiency and effectivity of the care delivery process and assist with Intake and Enrollment, including Medicare, Medicaid and PACE eligibility issues, as needed. He/she will work with all clinical assessment nurses and contract vendors to ensure excellent customer service to participants and CenterLight staff as well as prospects, referral sources, providers, and other external audiences. The Clinical Assessment Team Administrative Assistant will develop efficient and effective systems that ensure quality care and compliance with state, federal, PACE and organizational regulatory requirements.

JOB RESPONSIBILITIES:

• Coordinate and schedule all nursing visits for care delivery to ensure timely and efficient completion of required clinical assessments according to deadlines and regulations set forth by CMS/DOH and CenterLight.; and ensure timely and efficient completion of enrollments.
• Manage all the nurses’ calendars, including scheduling of nursing assessments, managing vendor assessments grids, cross referencing the data warehouse and ensuring accuracy and completion of paperwork/participant records.
• Administrative functions for Care Delivery/Clinical Intake, including producing, uploading, and mailing of Denial/Dispute letters.
• Reconcile vendor invoices to ensure accuracy for vendor payment.
• Serve as lead in weekly vendor meetings to address challenges with scheduling of nursing visits and intervene to facilitate resolution of obstacles in outreach to prospects.
• Enter calls/inquiries into central database for tracking and follow-up and schedule appointments with the prospect/participants/caregiver.
• Perform functions related to the enrollment process, including but not limited to, assistance with Medicaid, Medicare and/or PACE eligibility, helping schedule initial UAS-NY assessments and following up on required paperwork.
• Enter participant/enrollee information in the system with a high degree of accuracy.
• Compile statistical data and reports.
• Run UAS-NY/Lenavi reports as needed for oversight of prospect status, compliance with DOH/CMS/PACE requirements regarding timing of assessments and verification that tools are used to maximize case outcomes and collect quality measures.
• Run data and generate reports for CMS/DOH/PACE and Quality Improvement.
• Assist with the collection and review completeness of all required documents for processing enrollment transactions, upload required paperwork and monitor process in the data warehouse.
• Review enrollment submissions and forms for completion and accuracy and ensure appropriate follow-up.
• Participate to develop and implement effective systems and processes to ensure all required paperwork is completed and signed in a timely manner, including but not limited to, enrollment agreements and start of care documentation. Ensure all interactions and completed tasks are recorded in the data warehouse and monitored.
• Educate prospective participants, referral sources, providers/contracted vendors and/or other audiences on the enrollment process, requirements, timelines and regulations regarding PACE eligibility and enrollment.
• Ensure that clinical assessment processes and systems are updated to reflect any changes in government programs and/or regulatory requirements.
• Verify plan and entitlement status utilizing LDSS/HRA/CMS/EPACES etc. resources and functions.
• Perform provider network verification and other validation of provider participation.
• Monitor and report the clinical nurses’ performance measures to improve delivery and execution of assessments.
• Develop with new workflows and improve current ones to ensure and improve quality, efficiency and efficacy of clinical assessment processes and advise on operational improvements necessary to meet department and business goals.
• Work with all levels of the CenterLight Healthcare team in assisting with the resolution of Medicaid-related eligibility issues, pre-enrollment and as needed.
• Train all staff/nurses on virtual enrollment and data entry platforms, including Care Compass, DocuSign and Ring Central, etc.
• Fulfill materials request for nurses.
• Participate in developing trainings, policies, and standard operation procedures.
• Manage and respond to loss of entitlement issues, denials and appeals accurately. Respond to disenrollments timely and compliantly with excellent customer service.
• Meet regularly with direct reports to review goals, trends, and performance measures and to facilitate needed changes.
• Work with the Care Delivery, Business Development, Provider Relations and Marketing Teams to identify efficiencies with nursing assessments, as well as referral trends that will lead to conversion of eligible PACE candidates into the program.
• Maintain knowledge and compliance of all applicable CMS, DOH and PACE-specific guidelines esp. marketing, enrollment and disenrollment, including organizational and departmental policies and procedures.
• Ensure compliance amongst staff and contracted entities, with state & federal laws regarding Medicaid, Medicare, and PACE regulations.
• Promote CenterLight Healthcare’s initiatives and projects.
• Participate with quality improvement projects.
• All other duties assigned.

Section 3 – Job Qualifications

Experience:

• 2-3 years of experience with MLTC/MAP/PACE and healthcare preferred; primarily in administrative management responsibilities.
• Deep knowledge of community-based long term care services to dual eligible and frail adult population.
• Knowledge of Medicaid, Medicare and PACE regulations.
• Comprehensive understanding of federal and state regulatory requirements with respect to healthcare eligibility, coverage, and services of various public programs.
• Significant experience managing participant clinical information in a shared network/web-based environment.
• Excellent interpersonal skills, along with demonstrated ability to handle situations requiring immediate and urgent attention, while addressing routine and long-term objectives.
• Highly organized and flexible to meet submission deadlines.

QUALIFICATIONS:

Education:

• Bachelor’s Degree in Business Administration or related field or equivalent years of experience.

Experience:

• Excellent written and oral communication skills, familiar with medical terminology
• Significant experience managing Excel (Tables, Pivot Tables etc.)
• Computer Proficiency required in word, and statistical analysis and reporting.
• Experience with Care Compass preferred.
• Bilingual preferred.

Job Type: Full-time

Pay: $41,000.00 - $51,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Flushing, NY 11354: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Preferred)

Experience:

• Customer service: 1 year (Preferred)
• Health Care: 3 years (Preferred)

Work Location: In person

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