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Job description
Supervisory Medical Administration SpecialistDuties include but not limited to: The incumbent has full responsibility for organizing, planning, directing, and controlling work related to providing community inpatient and outpatient consult scheduling and authorization creation, management, tracking, resolution of claims and billing issues, outreach to community medical providers, review of unauthorized inpatient and emergency care for payment, and network management. The incumbent provides supervision, leadership, and oversight in planning, directing, and managing the integration of all administrative activities of the Community Care program. The incumbent interacts with VISN and VACO Community Care leadership, collaborates on problems and solutions, and ensures compliance with all federal laws, VHA Directives, and VISN and facility SOPs and policies. The incumbent monitors the community care network over a broad catchment area covering four states, communicates with community providers and facility administrators to resolve scheduling, billing, payment, and documentation interviews, and elevates problems to Third Party Administrator (TPA) executives as needed. Uses extensive knowledge of the capabilities and applications of multiple software systems required for Community Care workflow including VISTA (Veterans Integrated Systems Technology Architecture), HSRM (Health Share Referral Management), CPRS (Computerized Patient Records System), PPMS (Provider Profile Management System), Pyramid Analytics, Power BI, VHA Service Support Center (VSSC), Business Intelligence Service Line (BISL) and various other programs such as TPA (Third-Party Administrator) portals to ensure appropriate and adequate entry of data and optimal use of the systems by Community Care staff. Implements new programs and ensures staff are trained on new software applications and updates. Collaborates with service leadership and medical staff across the Medical Center to facilitate the development of Community Care programs and processes responsive to patient care needs. Provides opportunity for regular feedback between facility clinical staff and Community Care staff regarding patient care hand-offs, as well as volume/cost data. Serves as a liaison for the Medical Center with external medical providers and organizations. Establishes resources for sending Veteran care into the community that is of high quality, reliable, and timely. Builds and maintains collaborative relationships with community suppliers of multiple entities, to assure every opportunity for Veteran care is timely and of high quality. Recognizes the competitive environment of accessing community care, establishes partnerships that will withstand the ups and downs of the price/supply/demand equations. Administrative support and oversight of other functions as assigned by management. Develops close working relationships with VISN BIM (Business Implementation Manager), Deputy BIM, POM (Payment Operations Management) supervision and personnel, and TPA leadership and liaisons.Work Schedule: Monday to Friday 7:45am to 4:30pmTelework: ADHOC, as determined by the agency policy.Position Description/PD#: Supervisory Medical Administration Specialist/ PD -0Relocation/Recruitment Incentives: Not AuthorizedCritical Skills Incentive (CSI): Not ApprovedPermanent Change of Station (PCS): Not Authorized
Worksite address
johnson city, TN, 37601, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.