Administrative Officer 2 (Physician Claims Education and Monitoring Specialist) Correction - Jobs in Montague, PE

Job Description

Bi-Weekly Hours: 75 hours bi-weekly / Days.(Commencing Immediately until February 28, 2023)Health PEI values the different ideas, perspectives and backgrounds that a diverse, equitable and inclusive work-place culture can bring. Not only does this help us deliver better outcomes, more innovation, but it also creates a safer space for our patients when our employees are more reflective of the communities we serve. It is important for us to create an environment where our employees are comfortable bringing their authentic selves to work and challenging the status quo to make Health PEI a better more inclusive employer and healthcare system. We recognize we have more work to do but finding intentional ways to grow our understanding and support of those who have faced barriers due to accessibility, ethnicity, ancestry, gender identity, age, sexual orientation, language or other grounds is a key priority for us. We encourage underrepresented groups to join our team, be yourself, and help us achieve our vision of for an inclusive workplace and healthcare system.Reporting to the Manager, Physician Services, the Physician Claims Education and Monitoring Specialist provides billing education to practitioners and their staff to monitor physician claims in order to support Island Practitioners through building on a common understanding regarding the interpretation of the current Master Agreement between MSPEI, the Government of PEI and Health PEI. This position will help establish and implement programs and processes that improve accuracy, quality and efficiency in the billing claims data and processes for medical insured services.Duties: - Developing and maintaining a strong knowledge of the various billing account types and payment modalities and changes or amendments to the Master Agreement (which establishes the Tariff of Fees and other systems of payment for health services) in order to provide education and support to practitioners;- Developing and regularly updating orientation packages for new physicians in key specialties, with an overview of the Schedule of Fees, applicable guidelines and in-province payment claims and shadow billing procedures, an introduction to the Out–of-Province Referral Program, and the electronic link to the current Master Agreement.- Orientating each new physician to Health PEI physician claims and shadow billing by providing them with an orientation package and discussing the contents to clarify and interpret the complex claims and tariff codes;- Developing and maintaining a strong knowledge of the various billing account types and payment modalities, the current Master Agreement and amendments, and the Health Services Payment Act and Regulations and medical procedures;- Consulting the Senior Claims Auditor, Medical Consultant, and Manager, Physician Services to prepare a monitoring plan annually, or more frequently;- Requesting, monitoring, receiving and managing patient records from physician(s) for the claims monitoring program in an order that records and reports are secure, accurate, organized and accessible;- Providing support to claims assessment staff regarding the assessment rules in order to ensure proper adjudication of electronic claims according to the current Master Agreement tariff codes;- Receiving, investigating, assessing, and providing a timely response to inquiries from the Manager, Medicare Services and assessment staff to the application of billing tariffs (including shadow billing) based on knowledge and interpretation of current Master Agreement fee codes, Health Services Payment Act and Regulations, and internal policies;- Liaising between the Medicare claims assessors and physicians to address billing claim inquiries;- Other related duties as required.QualificationsMinimum Qualifications: • Degree or diploma from a recognized medical secretary, office studies, business, human resources or public administration program.• Extensive experience with validation of claims in relation to interpretation of complex payment agreements.• Detail oriented, comprehensive and focused to ensure that records, notes and analyses are accurate and able to withstand scrutiny.• Considerable experience in relationship building, collaboration, and team building skills.• Excellent interpersonal, oral and written communication skills in dealing with colleagues, health practitioners (physicians, dentists, nurse practitioners) and others on sensitive, complex, contentious and confidential billing matters.• Demonstrated ability to deal with individuals who are frustrated to resolve the situation, explain the processes and requirements and maintain professional respectful communications.• Extensive experience managing self and situations involving conflict with individuals.• Above average critical thinking, problem solving, and investigation and analytical skills.• Above average tenacity and ability to seek and interpret additional or clarifying information.• Extensive knowledge of the PEI Health Sector and the current Master Agreement, Tariff of Fees and Preamble) with the Medical Society of PEI, PEI Physician Claims Processing System, Health Services Payment Act and legislation.• Extensive knowledge of various payment schedules, allowable claims for procedures and time period, in-province payment schedules.• Ability to communicate monitoring findings in a timely manner.• Proficient in computerized environment with Microsoft Office programs and email.• Demonstrated ability to communicate, orally and in writing, in a manner that conveys information that is clear, concise and timely, to a variety of audiences that educates, and promotes understanding.• Must be independent, organized, and proactive in order to ensure goals and objectives are met in a timely manner. Innovative and motivated to enhance and improve the Division’s and physicians claims practices.• Training or experience in facilitation is preferred.• Additional relevant education and experience will be considered an asset.• Good previous work and attendance record.Important Notes: Covid-19 Immunization: Notice to all External Applicants. All new hires are required to provide proof of Covid-19 vaccination before their start date as per Health PEI’s Covid-19 Immunization and Management Policy. In the event that a new hire is unable to be vaccinated as a result of a medical exemption, you will be required to submit supporting documentation to Employee Health / Wellness and Safety.Please ensure the application clearly demonstrates how you meet the noted qualifications as applicants will be screened based on the information provided. We would like to thank all applicants for their interest; however, only those who are selected for an interview will be contacted.Please Note: Preference will be given to internal qualified members of the IUOE Bargaining Unit of Kings County.Successful applicants are expected to complete the term of temporary assignment unless appointed to a permanent position.Quick Apply

• Terms & Conditions
• New Privacy
• Privacy Center
• Accessibility

For Job Seekers

• Browse Jobs
• Advanced Job Search
• Emplois Quebec

For Employers

• Post a Job

Stay Connected