Job Openings >> Post Decisions Liaison Support
Post Decisions Liaison Support
Summary
Title:Post Decisions Liaison Support
ID:1125
Department:Operations
Description

Job Summary:  The Liaison Support performs a variety of duties. This position requires skill in planning, organizing and documentation of post decision activities. This person is responsible for processing and scheduling of requests for Peer to Peer reviews, notification of intent to deny services, and written and oral communication of post review outcomes.  This role supports the Clinical Liaison role and assists with post decision activities.  This position does not conduct any activities that require interpretation of clinical information.



Duties & Responsibilities

Receives and coordinates requests for post review discussions and Peer to Peer reviews.

Assures that all requests for Peer to Peer review and received and processed in a timely manner in keeping with department policy.

Responsible for handling of inbound and outbound communication with physicians, home care agency representatives, and members and/or member representatives in relation to adverse medical decisions.  

Using discretion and independent judgment in handling patient or physician complaints received, documents and forwards to appropriate administrative staff.

Documents all activity as directed and maintains electronic and/or hard copy files as directed.

Escalates abnormal situations to supervisor, making recommendations for resolution.

Communicates with patients and family in a kind and professional manner.

Gives explanations and verbal reassurances to patient and family.

Interacts professionally with all, including co-workers and other healthcare providers.

Fosters communication among healthcare team on the behalf of the patient.

Proficient with myNEXUS systems, operations processes, data entry, and basic computer skills for generation of daily office communication and record generation.

Answers the telephone and patient/provider requests in a timely and polite manner.

Communicates ideas for improvement to the supervisor.

Demonstrate proficiency in meeting and exceeding all required departmental goals and objectives.

Reflects knowledge and judgment in decisions and actions within the job description of the Operations Coordinator.

Must be able to demonstrate team behavior and must be willing to promote a team-oriented environment.

Maintains complete and accurate patient care records within company platform.

Demonstrates high level customer service skills, both internally and externally.

Accepts additional assignments willingly.

Supports the Mission and the Core Values of myNEXUS

Performs other duties as assigned.


 

Job Requirements

Educational Requirements:

  • High School diploma or the equivalent.

Language Skills:

  • Ability to read and communicate effectively in English.
  • Additional languages preferred.
  • Ability to read, analyze, and interpret insurance and medical documents. Must understand and communicate effectively with providers and insurance representatives. 
  • Ability to respond to common inquiries or complaints from providers, patients or family members. 
  • Must demonstrate the willingness to work in a team environment and be a team player.
  • Possesses the ability to adjust to constantly changing work flows and processes.

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to recognize clinical documentation form a verity of sources and determine the appropriate process to follow.  

Other Skills:

  • Shows proficiency with computer programs which may include Microsoft Word, Excel, PowerPoint, Outlook and others.
  • Strong administrative, clerical and organizational skills.
  • Excellent customer service and follow-up skills.
  • Strong attention to detail and accuracy.
This opening is closed and is no longer accepting applications
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