Delivers customized analyses, leveraging internal and external as well as structured and unstructured datasets Utilizes advanced modeling techniques; handles large data sets Identifies gaps in existing reporting and analytical processes, taking immediate action to address. Shares professional recommendations and preferred course of action with leadership and external stakeholders Influences decision making at highest levels of the organization Prepares and communicates complex information to a wide range of technical and non-technical audiences Take ownership of several team development efforts, including but not limited to tightening up data intake documentation, formalizing testing procedures, and helping maximize data quality in onboarding members.

This position organizes and leads technical implementations with new and existing customers to build and test data submissions and to ensure that the data received by Vizient has outstanding integrity and accuracy. The high quality data that results from successful implementations is used as comparative data to populate metrics for clinical, operational, and financial performance. Customers’ data also feed benchmarking tools and reports that are used to support customers in their efforts to meet challenges and improve efficiency to remain competitive in the healthcare marketplace. The position also performs advanced tasks to support overall team function as assigned.

•Performs intake of calls from members or providers regarding services via telephone, fax, EDI. Utilizes systems to build research and enter member information. Screens requests for appropriate referral to medical services staff. Approve services that do not require a medical review in accordance with the benefit plan. Performs non-medical research including eligibility verification, COB, and benefits verification. Promotes communication, both internally and externally to enhance effectiveness of medical management services. Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures. Places outbound calls to providers under the direction of Medical Management Nurses to obtain clinical information for approval of medical authorizations.

Performed all activities of Admitting (admitting, transfer and pre-admissions, etc.) for ER and inpatient types. Completed all paper processes for complete and accurate admission including all HIPAA requirements. Worked under the direct supervision of the Patient Access Manager. Established and maintained professional working relationships with all customers of Admitting, including but not limited to patients, visitors, hospital staff, hospital administration, hospital leadership team members, physicians and physician office staff. Ensured the most effective handling of patient admissions, transfers and pre-admissions. Obtained and verified patient demographic, financial and religious information. Created appropriate admission papers and patient identification band. Obtained consent for treatment and financial responsibility agreement from patient and/or responsible parties. Provided and obtained necessary signatures as required by HIPAA.

Worked with teaching contracts for doctors – reviews and signatures, Tracked risk credit and different malpractice law cases in a spreadsheet to add information and updates. Collected and reviewed Scope of Care and Staffing Plans from all the ambulatory sites. Sent out notices to doctors who had delinquent medical records. Worked on Ambulatory Policy and Procedural Manual