Greenville, SC, 29602, USA
5 days ago
Bariatric Quality Specialist - Clinical Reviewer
At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Position Summary** Verifies insurance benefits, schedules surgical procedures, completes insurance pre-assessments, and navigates patients through program. Abstracts quality improvement data from the bariatric patient records and health system department/service logs assumes responsibility for accuracy and timeliness of data and prepares data reports. This position collects, compiles, abstracts, and enters data into the ASMBS/ACS registry of data in adherence to COE guidelines. Assists the Program Manager with planning, organizing, coordinating and directing the functions of the Bariatric Department. Abstracts quality improvement data from the bariatric patient records as the program’s dedicated data collector and bariatric surgical clinical reviewer. This position collects, compiles, abstracts, and enters data into the ASMBS/ACS registry of data in adherence to COE guidelines. Assist with referrals, appointment scheduling, insurance verification and prior authorization, and surgery scheduling. Assists the Director with planning, organizing, coordinating, and directing the functions of the Medical and Surgical Weight Loss Department. + Demonstrates effective positive communication with patients, families, staff, physicians, and visitors. Maintains confidentiality of all patient and employee information. Answers telephone professionally and courteously in efficient manner; personally addressing needs or directing to appropriate person. + Abstracts Quality Improvement data from the bariatric and/or medical weight loss patient record and health system department/service logs assumes responsibility for accuracy and timeliness of data entry into computerized departmental database. Collects, compiles and enters data into the ASMBS/ACS data registry in a timely manner for monthly statistics to adhere to COE guidelines. Enters data, in various forms, into EMR and program software. + Responsible for assisting with patient intake process, addresses interested patient questions and inquiries, provides necessary paperwork, and schedules program visits. + Assists with medical and surgical weight management referrals through patient outreach and relays information to referring offices. Completes appropriate EPIC referral pathways. + Assists with verification of insurance benefits on patients; communicates to patient, copay and deductible responsibilities, expectations, and coordinates collection of payment. + Reviews and organizes patients’ medical records to ensure appropriate documentation is obtained for pre-certification process. Obtains precertification information. + Accurately schedules surgery and preassessments with the performing surgeon’s office personnel and hospital. Maintains and monitors the surgery schedule. Communicates pertinent changes regarding the surgery schedule to the appropriate personnel. + Attends necessary team meetings and required MBSAQIP meetings. Attends meetings, in services, training, and participates on committees as required. + Supports Bariatric Quality Coordinator in accurately scheduling surgery and preassessments with the performing surgeon’s office personnel and hospital. Maintains and monitors the surgery schedule. Communicates pertinent changes regarding the surgery schedule to the appropriate personnel.Enhances professional and personal growth development through educational programs **Employment Qualifications** **Education:** HS diploma required **Experience:** 2 years Surgery Scheduling experience preferred Medical Terminology required Proficient with the computer and business related software programs to include, but not limited to: Microsoft Word, Excel, Tyger/Mysis, Internet Applications, Google Calendar & Connect Care (all listed are required) Must possess: + Ability to work independently with minimal supervision + Ability to review medical records and evaluate findings appropriately + Excellent organizational, analytical and problem solving skills + Ability to build strong relationships within and outside of the organization + Ability to manage a variety of complex issues while working on key projects + Excellent interpersonal/communication skills + Ability to work effectively and collaboratively with physicians, administrators and other professionals + Ability to adapt to an ever-changing environment **Behaviors:** Must have a positive, enthusiastic attitude and demonstrate the ability to maintain a pleasant and professional demeanor at all times. **Age-Specific Competence** : Demonstrates competence to provide psychosocial and sensitive care to the Obese Adult and Geriatric Age Groups Many of our opportunities reward* your hard work with: Comprehensive, affordable medical, dental and vision plans Prescription drug coverage Flexible spending accounts Life insurance w/AD&D Employer contributions to retirement savings plan when eligible Paid time off Educational Assistance And much more *Benefits offerings vary according to employment status All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com
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