Medisaw Specialist

at  The Chickasaw Nation

SAVE

Description
We are currently looking for a Full Time Medisaw Specialist to join our Claims and Contracts Team team located at the Chickasaw Nation Medical Center.

SUMMARY:

Provides administrative and technical support in providing third party health care to eligible beneficiaries.

SKILLS:

Essential:

• Must be able to operate a computer and/or other equipment related to specific role (i.e. automated currency counters, calculator, projector, binding machine, other related office equipment)

EXPERIENCE:

Nonessential:

• 3 years directly related experience

EDUCATION:

Essential:

• High School, GED or Equivalent

• Provides first class customer service - courteous and helpful to all internal and external customer types
• Answers questions in a courteous and professional manner
• Partners with internal and external services as needed to ensure appropriate referral is made
• Greets and engages with a smile
• Determines needs, seeks positive experience and outcomes
• Completes all training and development requirements and participates in continuing education opportunities
• Works in a collaborative and supportive manner to support the productivity and safety of the work area, team members and customers of all types
• Maintains general upkeep of work area and maintains a safe environment
• Maintains and promotes professionalism
• Punctual and consistent in meeting start time, work schedule, attendance and other assigned work time metrics
• Adheres to Chickasaw Nation dress code standards
• Maintains knowledge of and follows all laws, rules, regulations, policies and SOPs for assigned area, e.g. MICS, TICS, hospital standards, health codes, food sanitation, accounting principles, etc.
• Maintains files, logs, and records
• Prepares individual and group correspondence
• Assists with the composition and preparation of routine correspondence, drafts, and narratives
• Maintains spreadsheets and databases and inputs data entry
• Answers the phone, transfers calls, takes messages and screens calls per guidelines for areas served
• Procures health services from private providers through written contracts and agreements within established policies and procedures
• Negotiates and awards purchases of health services within delegated guidelines and procedures
• Assists medical staff in preparing referrals for submission to Medisaw Review Committee
• Processes Medisaw requests according to determination made by committee
• Assists patients in filing claims for medical services involving alternate third-party resources
• Prepares high costs cases for submission to the Catastrophic Health Emergency Fund for funding reimbursement
• Provides patients and outside providers information related to Medisaw guidelines, policies and procedures
• Assists in scheduling appointments and travel arrangements for patient if necessary
• Performs all other duties as assigned