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Call Center Medical Appointment Line Clerk

Company:
Entourage Consulting LLC
Location:
Brandon, Suffolk, IP27 9PS, United Kingdom
Posted:
January 31, 2023

Description:

Call Center Medical Appointment Line Clerk

Place of Performance: RAF Lakenheath, UK

General Description:

Call Center Medical Appointment Line Clerk shall engage with patients through phones and electronic means to answer/place calls and answer/place electronic messages in both specialty appointing, primary care appointments and/or referral management.

Specific Tasks:

• Perform within one or more of the following business lanes: Appointing Management or Consult Management with regard to primary and specialty care.

• Utilize the Automated Call Distribution (ACD) system and TRICARE Online Patient Portal Secure Messaging In Accordance With (IAW) established protocols and where applicable, use Standard Operating Procedures (SOPs), Booking Protocols, and Business Rules in combination with developed skill sets in the execution of the MTF mission. Shall meet or exceed the required metrics in accordance with Air Force Instruction. DoD, DHA, AF and MTF policies & instructions.

• Handle inbound ACD routed calls with each average handle/transaction time per month of less than or equal to one hundred and eighty (180) seconds per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds.

• Answer 90 percent (90%) of all inbound ACD routed calls with each average answer time per month at ninety (90) seconds This metric is known as Service Level. No individual day or hour average shall go below 75 percent (75%).

• Handle inbound ACD routed calls with each average speed of answer per month of less than or equal to 45 seconds per call. No individual day or hour average shall exceed ninety (90) seconds.

• Manage inbound ACD routed calls to prevent calls from being dropped. Dropped calls shall not exceed, 8 percent (8%) of all answered calls. No individual day or hour average shall exceed 15 percent (15%) seconds.

• Record 100 percent (100%) of all inbound ACD routed calls.

• Make outbound calls with each clerk’s average handle/transaction time per month, of less than or equal to one hundred and eighty (180) seconds per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds.

• Utilize the Composite Health Care System (CHCS) Managed Care Program Module, Assignment Order Processing Module, or any Air Force mandated system(s), to identify appointment availability, schedule, cancel, and reschedule appointments, following local directives, established protocols, Booking Protocols, and the MTF Business Rules using the appropriate Access to Care (ATC) category, matched to the appropriate standard appointment types, and detail codes within the appropriate ATC standards.

• Generate or receive, and electronically deliver, telephone messages (t-cons) to medical providers and clinic support staff by using CHCS or AHLTA, or any Air Force mandated system(s), per individual clinic guidelines; and any other applicable DoD, DHA, AF, and MTF policies & instructions.

• Shall take the following actions concerning specialty care consults/referrals:

a) Disposition referrals as “Appoint to applicable MTF, RAF Lakenheath, RAF Alconbury, and RAF Croughton” or “Defer to Network” within one (1) business day of receipt in accordance with Air Force Instruction, and the DHA Interim Procedures Memorandum. DoD, DHA, AF and MTF policies & instructions.

b) Review referrals for administrative completeness, covered TRICARE benefit and required tests and pre-work. Coordinates with referring providers in cases where additional referral information is required.

c) Book specialty care consults/referrals when contacted by the patient and the referral is dispositioned as “Appoint to RAF Lakenheath MTF. If the referral is dispositioned as RAF Alconbury or RAF Croughton, you will transfer the call to the appropriate referral line.” If the referral lacks a review disposition when the patient calls, then you will provide a “warm hand-off” to the specialty clinic to immediately review the referral and appoint or defer it.

d) Proactively contact patients with active specialty referrals until the specialty or behavioral health care appointment can be booked, the patient cancels the referral, or the message has been delivered three (3) times (first message NLT day 3 and final message NET day 14). Each contact attempt will be documented in CHCS or any Air Force mandated system(s).

e) When the MTF cannot offer three (3) different appointments within the access to care standard, you will inform the patient that the specialty referral can be deferred to the network and will offer the patient an MTF appointment outside the standard. You will process the specialty referral according to the patient’s preference.

f) Assist with ROFR determinations for specialty care that can be provided within the MTF using Service Availability (Capability) Listings and information systems that link the referral to the appointment to the ATC category and standard. ROFR shall be processed within the time limits outlined in the TRICARE Operations Manual.

g) Perform/assist with appointing network specialty care referrals as allowed by the TRICARE Overseas Program (TOP) Contractor.

h) Close all un-appointed referrals accepted by the MTF NLT 180 days beyond the order date.

i) Manage the “cancellation line” feature, ensuring that when patients call in to cancel appointments by leaving voice mail, you shall 60 message and go into AHLTA/CHCS, or any Air Force mandated system(s), to cancel the applicable appointment within same day or coordinate with the appropriate clinic to get the appointment cancelled within the same day.

j) When patients request to cancel a specialty referral appointment or consult, you will document the cancellation reason in CHCS, or any Air Force mandated system(s), and send a t-con to the referring provider within one (1) business day of the cancellation. No individual weekly timeliness average of cancellation notifications will exceed two (2) business days.

• Verify beneficiary eligibility, using patient’s DOD ID number and two (2) patient identifiers, refer patient to DEERS and update patient demographics in CHCS per DoD Healthcare policy, and local MTF policies.

• Attend all training activities, per local MTF policies. Training may include but is not limited to topics designed to increase skills, enhance workflow or communication, update on standard operating procedures, adjust to changing mission requirements, address facility or installation issues or increase overall effectiveness and efficiency of operations.

• Complete all required training within the first month of assignment and be able to perform all functions required.

• Provide patients with specific instructions for their appointment/referral following local directives, established protocols, SOPs, Booking Protocols, and the MTF Business Rules.

• Perform other administrative and clerical duties in support of the medical care and operational support as required.

• Advise patients of the provider, location, time and day of their booked appointments.

• Coordinate with specialty referral clinics (e.g., internal MTF, Veteran’s Affairs clinic, etc.) on special patient instructions and tests required prior to appointment.

• Track initial specialty care and deferred to network primary care referrals to include obtaining reports from MTF, network, and non-network providers. The primary responsibility to obtain Network and purchased care results will be with the MTF.

• Process initial specialty care and deferred to network primary care reports in the HAIMS following the business rules, DoD, DHA, AF and MTF policies & instructions, close the specialty referral in CHCS, and send a t-con to the referring provider or PCM within three (3) days of receipt of the report. No individual weekly timeliness average of network report notifications will exceed five (5) business days.

• Initiate efforts to capture network reports upon request of the referring provider or no later than 60 days from the date the specialty referral was ordered or as soon as a claim is discovered, whichever occurs first.

• When a CLR has not been received or documented in the EHR, the RMC will check the applicable claims database for a claim.

• If a claim is found, the RMC will request the CLR from the rendering purchased care provider. If there is no response from the provider within 10 calendar days, repeat. If the provider still does not provide the CLR, the RMC will close the referral in CHCS using the status of “Deferred results received” and annotate {CRNRR} in soft brackets in the CHCS Review Comment Field indicating a claim was reported but no results were received. Notify the referring provider. Initiate TRICARE contractor procedures as per the TOM and/or the Memorandum of Understanding (MOU) with the TRICARE regional contractor. Additionally, forward a report to the TRICARE Regional Office each month that lists all provider names, specialty care rendered, and referral Unique Identifier Numbers for which no CLR has been received after two attempts or per MOU.

• Close all open specialty referrals deferred to the network NLT 180 days beyond the order date.

• Pull NAL reports and enter them into AHLTA under the appropriate clinic.

• Use TOL Patient Portal Secure messaging to:

a) Register beneficiaries for TOL Patient Portal Secure Messaging Accounts IAW established protocols.

b) Out-process beneficiaries from TOL Patient Portal Secure Messaging when the member PCSs, separates, retires, or any other reason where the member no longer needs access to the system.

c) Communicate with beneficiaries for scheduling appointments or concerning the use/activation of referrals.

• Answers main office phone line(s). Directs telephone calls to appropriate section for assistance, handles independently or takes messages as required.

• Reviews referrals for administrative completeness and researches covered benefits prior to processing.

• Determines patient eligibility for services and arranges and schedules medical appointments for referred care.

• Provides general instructions to patients and ensures patients have necessary documentation for referred health care services.

• Obtains updates and files medical records as needed.

• Organizes and researches patient records, extract needed information, and review records for referral within established guidelines.

• Request medical records and ensures arrival of medical records prior to appointment(s).

• Initiates and locates patient medical records as needed.

• Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records).

• Ensures referral results are returned to the referring provide and to the medical record within required timelines. Assists with follow up, written or verbal, as necessary.

• Utilizes the referral tracking data collection tool. Calculates metrics, and compiles monthly reports, as directed by the MTF.

• Orients and trains MTF personnel about the referral process and timelines.

Education:

• Shall possess a high school diploma or General Educational Development equivalency. Completion of administrative assistant program is desirable.

Experience:

• At least six (6) months of experience in medical office doing scheduling or referral management.

• Customer Service Training/experience.

• Basic knowledge and skill level includes: principles of excellent customer service; TRICARE benefits; quality control and risk management; medical terminology, medical forms and records management; HIPAA guidelines for release of medical information; general medical and legal ethics; excellent communications skills; strong organizational skills; and computer operations, including operational skills with Microsoft applications (Windows Operating system, Microsoft Word, Microsoft Access, and Excel,); personnel shall understand the importance of meeting deadlines.

• Knowledge of current ICD- 10 (International Classification of Diseases, tenth revision) coding desirable, but not required.

• Shall have functioning knowledge of Government appointing MHS Guide to Access Success and referral management business rules (AFMS RMC Guide), Government appointing information systems, DHA, TJC or AAAHC, UEI, HIPAA, DoD Health Information Privacy Regulation, the Privacy Act, and DoD Privacy Program.

Certifications:

• Required to obtain a certification in Basic Life Support (BLS).

Knowledge and Skills:

• A fully qualified typist (computer keyboard) with a minimum of 50 Words per Minute is required.

• General office administrative and clerical skills to perform receptionist duties and answer telephones.

• Standard office equipment, such as personal computers, copiers, fax machines, and telephone systems.

• An understanding of general medical ethics, telephone etiquette, and excellent communication, to be able to actively convey information through the exchange of thoughts, messages, or information, by speech or writing, with excellent customer service skills, a professional demeanor, appropriate interaction with clients and able to promote the best image of the government.

• Able to read, write, and speak English well and should not suffer from any reading, writing, speaking or hearing limitations, so as to ensure effective communication with customers on the phone.

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