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013450 CCA-Health Information Mgmt.

Position Summary:

Reporting to the Director of Health Information Management, the Senior HIM Specialist is responsible for following processes to ensure compliant validation and entry of Authorized Representative documents into member Centralized Enrollee Record (CER) and SalesForce.

Supervision Exercised:

• No, this position does not have direct reports.

Essential Duties & Responsibilities:

• Ensures all Authorized Representative documents received in the Health Information Management Department are routed to the Member Services Department to be entered into SalesForce.

• Reviews and validates all Authorized Representative documents.

• Enters validated information into SalesForce and Guiding Care.

• Uploads validated Authorized Representative Documents into Guiding Care

• Collaborate with the Compliance, Legal and Privacy Departments.

• Communicates to HIM Director any discrepancies with AR documents and escalates as appropriate.

• Communicate with CCA Members as appropriate.

• Gather and log data obtained or released by CCA for tracking and metrics.

• Obtain documentation from outside EMRs in preparation of HEDIS review, MDS assessments.

• Request and review paper records from external organizations if/when EMR is not accessible.

• Provide and obtain release of information documentation to and from members, clinicians, partnering organizations.

• Follow all HIPAA guidelines for compliant release of information.

• Responsible for recording accurately and consistently in CCAs electronic medical record.

• Support clinical teams by obtaining medical record requests in a timely manner

• Process Ad hoc telephone encounters and new enrollments within 48hours.

• Other responsibilities and duties as assigned.

Working Conditions:

• Standard office conditions.

Required Education (must have):

• Higher education in Health Information Management – minimum of associate degree.

• Registered Health Information Technician (RHIT) and/or Registered Health Information Administrator (RHIA

Required Experience (must have):

• 2 years experience in a medical office or equivalent combination of education and experience.

Required Knowledge, Skills & Abilities (must have):

• Knowledge of medical terminology, anatomy and physiology, medical procedures, medications, and laboratory test both one on one and in group settings.

• Knowledge of HIPAA regulations

• Release of Information experience preferred.

• Ability to function in a faced paced setting with a variety of patients and staff.

• Attention to details and prompt follow-up

• Interest in professional growth

Required Language (must have):

• Secondary language is not required but a plus.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.