Tuesday, November 27, 2007

Search Firm Looking For Person With Medicare Experience

(CONTACT JANINE PAPPENFUSS AT SC CAREER SERVICES)


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From: Jenkins Consulting Group, LLC [mailto:cjenks@vcn.com]
Sent: Wednesday, November 21, 2007 11:38 AM
To: Janine Papenfuss
Subject: PappenfussJ ET re Reimbursement Specialist 112107



Dear Janine,



Thank you so much for the return phone call Janine. Below please find a job description for a Reimbursement Specialist. A client I am working with has an immediate need to fill this position. The job is located in the suburban Chicago area.



The client also has an immediate need for some consulting assistance with testing a claims payment information system used to process Medicare claims according to fee for service methodology. The consulting work would be to develop various claims scenarios to test the IT system and processes to verify the financial and procedural accuracy of claims processing. The ideal consultant would have very recent Medicare FFS claims processing experience having worked for a carrier or fiscal intermediary or consultant to a carrier or intermediary. Detailed knowledge of Medicare prospective payment systems is required. Some travel to the Chicago area would be required. Approximate engagement time would be now and most likely through the first quarter of 2008.



If you have any candidates, please have them contact me at 320-363-7880.



Again, thanks so much!



Carol Jenkins



GENERAL PURPOSE OF THE JOB: The Reimbursement Specialist will be responsible for accurately, and in a timely manner, responding to all reimbursement issues as requested by the provider community. The position will be responsible for keeping current with Medicare reimbursement policies and procedures. It will also play an active role in the development of educational materials for providers.



SUPERVISORY RESPONSIBILITIES: None



ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive.



- Consistently updates knowledge of regulations, procedures and standards pertaining to Medicare claims payment to assure compliance with contractual obligations and directives from governmental and regulatory agencies, fiscal intermediaries and contracting entities.

- Responds to all provider inquiries relating to Medicare claims submission and payment.

- Contributes to the development and dissemination of claims submission educational materials to support the improvement of provider claims submittal

- Contributes to the development of provider educational presentations which will include bulletins, newsletter articles and distribution pieces.

- Will support the Manager of Contracting by updating trends in types of calls/requests, changes in Medicare payment regulations, etc

- Troubleshoot payment obstacles of government programs. Resolves issues or confers with Manager to achieve solutions.

- Work with Contract Manager to implement and maintain written policies and procedures



MINIMUM QUALIFICATIONS

(Education, licenses, certifications, and experience required to fulfill the essential duties, include computer skills as required):



- College degree or equivalent with minimum five years experience in Medicare reimbursement

- Understands Medicare billing/coding and has experience with ICD9, CPT, HCPCS, RVU, DRG, and APC

- Experience with CMS 1500, UB04 and electronic claims submission

- Understanding and compliance with HIPPA regulations

- Ability to access and navigate CMS website data i.e., Federal Register, Medicare policies, etc.

- Knowledge of Medicare reimbursement models

- Ability to think strategically

- Strong customer relations skills

- Goal and team oriented

- Experience with dual-payer relationships

- Computer literate, experience with Word, Excel, PowerPoint and Access

- Ability to handle ever changing fast-paced environment

- Excellent written and oral communication skills



ESSENTIAL BEHAVIORS AND ATTITUDES REQUIRED FOR SUCCESS IN THIS POSITION:

• Commitment to values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment & Fun with ability to demonstrate those positively and proactively to patients, co-workers, management, physicians, and/or vendors.

• Must have excellent communication skills with the overwhelming desire to customer satisfaction.





LANGUAGE SKILLS:

Fluent in the written and verbal skills necessary to perform successfully the essential functions, duties, and responsibilities of the position.



Vision requirements.

Vision adequate to perform essential duties and responsibilities of position.



PHYSICAL DEMANDS

Physical requirements can vary. These must be reviewed with management. However, in general, the position requires the following physical activities:



None





WORK ENVIRONMENT

Typical office noise environment.

Tuesday, October 30, 2007

HCM Program Growth

It is exciting to post that we currently have 72 students enrolled in the health care management program. We have approximately 23 students that enroll in the oline HM courses on a regular basis as we progress through the core HM courses. Last quarter we completed HM 110 US Health Systems, and this quarter we are completing HM 150 Health Politics and Policy. It is enjoyable to watch students learn to think as health care managers and begin to understand the complexities of the US health care system.

Wednesday, October 24, 2007

Key To Using Job Posting Links on this Blog

To find Health Care Management positions using the links identified in the upper left corner of this blog, you will need key words to find job opportunities listed by the organizations. When you enter the link, use the following key words to drill down for job announcements: Professional, manager, managerial, supervisory, non-manager. In some instances you can also identify locations. You need to open listings to determine job descriptions, educational requirements, and experience.
Seldom will you find a position titled 'health care manager.' Once you become familiar with the link, you may find postings such as 'project manager,' 'project director,' 'program lead,' 'program director,' 'clinic manager,' 'ancillary department director', 'associate director', analyst, and coordinator. These are only a few examples of key words used to find health care manager positions.
Remember, it is valuable to become familiar with the job links, and it is valuable to call and schedule an 'informational interview' with the Human Resource person for the organization. Health care organizations and businesses are very interested in talking with potential graduates in health care management at the bachelor degree level.

Begin Developing Your HCM Job Network

There are 4 MAJOR EMPLOYMENT SECTORS in the Health Care Management Field:

1) Health Care Providers
a. hospitals
b. group physician practices
c. clinics
d. nursing homes
e. outpatient care centers
f. mental health organizations
g. rehabilitation centers

2) Health Care Suppliers
a. biotechnology companies
b. pharmaceutical firms
c. health care management companies (ex:consulting)
d. educational organizations (American Hospital Assn; American Nursing Assn)

3) Insurance Organizations
a. health maintenance (HMO's)
b. preferred provider orgs (PPO's)
c. private insurance tht caters to health care market
d. state and federal health insurance programs (medicare, medicaid,etc)

4) Policy Organizations
a. federal, state, and county departments
b. public health
c. non-profit organizations
d. health oriented mission organizations

If you want to learn more about a specific area related to health care management, it is beneficial to schedule an 'informational interview' with the Human Resource person of the organization you would like to investigate. Get your name in front of the HR person as you build your job network for the future.

If you have any questions, you may contact me or an advisory board member, who will be more than willing to provide advice to you.

Monday, October 8, 2007

Care Management or Integrated Health

Wall Street Journal Sunday edition had an article by M.P.McQueen on Health Costs.

In essence, large companies like Ford, PepsiCo have contracted with Care Managers to work with employees and workers help manage their medical care, right down to adding services that arrange for doctor's second opinions and suggest specialists and hospitals.

The article claims Care Managment to be the BIG trend in employer-sponsered health sphere.

On the positive side, care mangers use latest techniques like data-mining and reviewing best practices to help patients and reduce cost by recommending less invasive and less expensive procedures and drugs.

On the flip side, patients can easily find care managers to be intrusive. Also, can patients trust care managers hired by employers or in other words, are employers motives purely altruistic?

Interesting article raising very legitimate concerns.

Thoughts?

The "missing class" of people

The are 34 million people in the United States who meet the 'poverty' criteria to receive assistance for health care services. There are 53 million people who do not qualify for assistance because they have an annual income between 20K and 40K per year (family of four).
In reviewing this group of people who pay their taxes, and assume responsibility for raising their children, they do not qualify for health care assistance based on their gross income. According to recent literature, these families strive to participate in "middle class" dreams, but cannot affor to pay for their health care insurance. They are being referred to as the "missing class" or families that get overlooked in their struggle to maintain a quality of life for their family.
Let's hope that we don't see more and more families slide into the "missing class" and have access to health care services.

Wednesday, October 3, 2007

Have a degree? A Veteran? UnitedHealth Group Position

At UnitedHealth Group, we are a healthy business in more ways than one. We are a Fortune 100 company identified as the first or second most admired company in the health care industry by rankings published in Fortune magazine since 1995. We also have the privilege each day – directly or indirectly – to make a significant difference in someone's life. Sound like a rare combination? It is. Join us and you’ll be inspired to discover your own mix of professional advantages and personal rewards.



Director, Government Programs (Military & Veterans Health Services):

This position provides leadership, management skills and utilization of outside resources to accomplish the goals and objectives that translate into profitable lines of Military & Veterans Health Services business for the corporation.

Develops strategic and tactical business plans for military health including operational goals, performance targets, profitability targets and SG&A.
Organizes and leads the efforts of department managers across UHG to achieve effective and efficient coordination of all departments.
Develops an organization structure, operational standards, and policies and procedures to meet the objectives of overall operations.
Recruits and hires qualified staff and provides for their training and development.
Sets performance expectations and goals, evaluates performance results, provides feedback to managers and administers appropriate rewards.
Fosters a cohesive and supportive team environment.
Prepares and is accountable for the product operations budget.
Monitors spending levels against the plan and takes corrective action as needed to ensure operational objectives are met within established spending limits.
Reviews the product design and pricing on an annual basis to maintain a competitive position.
Maintains working knowledge of defense regulations, the managed care industry, the competitive environment, pertinent legislation, etc.
Establishes and maintains a high profile in the health care community by serving on various boards, committees, and task forces at county, city, state and federal levels to gain credibility in the health care community and influence public policy as it affects military and veterans programs.
Establishes and maintains a continuous liaison with federal officials and legislators to gain direct access and input on legislative and administrative issues affecting the financial and enrollment success of the military and veterans programs.



Qualifications
Bachelor's degree or equivalent work experience.
Master's degree preferred.
Eight plus years experience in a managed care or health insurance industry desired.
Previous military or veterans health experience preferred.
Six plus years management experience in a managed care/insurance environment preferred.
Knowledge of defense regulations and standards preferred
Extensive understanding of goals, processes, procedures, jobs and dynamics of managed health care.
Ability to travel.
Adept at understanding complex concepts and situations presented by the business environment.
Quickly assesses complex problems and selects the appropriate solution. Possesses very strong consultative skills.
Influences much of the business through direction of teams.
Decisions made effect the profitability of the business segment.
Knows products and services sold in their market.
Clearly explains the difference between products.
Selects the correct product or service for the customer's situation.
Sees trends in products and services.
Possesses expert underwriting, financial and analytical skills.
Leads teams in any project related to the selling environment.
Gives directions and brings the project to fruition.
Develops work plans to effectively manage projects.
Translates business strategies into clear objectives.
Builds internal networks and consensus to shape decisions of upper management.
Builds and maintains positive, constructive working relationships with senior levels as well as internal and external customers.
Balances the big-picture concerns with day-to-day activities.
Links business operations and business plans to that of broader organization. Identifies critical high-payoff strategies.
Solid understanding of the company's mission, strategy, strengths and weaknesses

Client Relations/Park Nicollet/One Year College Required

Specialist, Client Relations
Job ID #: 20577 Location: Park Nicollet Clinic--Airport (Occupational Medicine), Minneapolis
Position Category: Administrative / Clerical Department: Airport Ohsm Bus Health 2011
Employment Type: Full Time Education Required: High School Diploma or equivalent (GED)
Experience Required: 1+ years Union Representation: Non-Union (100)
Work Schedule m-f, days


Position Summary

Gains and communicates a deep knowledge of OHSM business customers accessing PNC-Airport primarily by telephone. Coordinates standardized quality occupational health services required by client companies and provides results of services to the company in a timely and effective manner. Provides account maintenance for customers with standardized service needs including accurate customer profiles for products, services, pricing and demographics.

Education/Experience:
Experience in customer relations and health services is desired. Must have the ability to attend to detail, assess and follow up on problems using a team based approach. Able to work independently as well as in a team with minimum supervision. Minimum one year of college preferred.

Special Knowledge/Skills/Certifications/Licenses:
Excellent verbal and written skills
Knowledge of occupational health standardized products
Computer proficiency
Excellent customer service skills
Ability to prioritize work to meet customer needs

Additional Information

The Organization



Rooted in suburban Minneapolis, Minnesota, Park Nicollet Health Services (PNHS) is an integrated health care delivery organization. The two largest entities that comprise PNHS are Park Nicollet Methodist Hospital, a 426-bed community hospital located in St. Louis Park, and Park Nicollet Clinic, a 500-plus, physician multi-specialty group with 25 offices in Minneapolis and its southern, western, and northern suburbs. PNHS truly is an integrated system, as processes of care are designed and managed across these entities to optimize the delivery of care for the patients and communities served.



Park Nicollet Mission, Vision and Values



Mission:
Our mission is to care for and support the health, healing and learning of those we serve.



Vision:
Everyone caring, every day, creating with the individuals we serve, optimal health and greater value.



Values:



Excellence is the standard we apply to our work, achieving best possible outcomes and upholding the highest professional standards.



Caring is our heartfelt motivation to serve our patients and create the best possible experience.



Stewardship is our commitment to create ever greater value with the resources entrusted to us.



Joy is what we experience when serving our patients and each other through a job well done.



Learning is the way we continually improve and create knowledge and value that can be shared.



What makes us unique?



Park Nicollet Health Services is a strong, stable and organically grown multi-specialty group practice within the affluent and highly educated western Twin City metropolitan area. PNHS has a long-standing commitment to quality, proficiency and stewardship, and has embarked on a pioneering effort to study, adopt and integrate the Toyota Production System’s Lean Methodology (Kaizen), enhancing previous gains realized from its Six Sigma efforts. Although PNHS has developed and engaged in strong business partnerships with local competitors, having a single hospital focus adds to its list of strengths and advantages. PNHS was one of the first integrated healthcare systems in the nation to adopt a unit medical record that is now electronic and ubiquitous.



To learn more about our organization, including our award winning care, please visit our website at www.parknicollet.com.

Example of positions available...AA degree req'd/coding/Park Nicollet

Job ID #: 20020 Location: Westside Business Center, Hopkins
Position Category: Professional / Non-Leadership Department: Compliance Review & Education 8914
Employment Type: Full Time Education Required: Associate's Degree
Experience Required: 2+ years Union Representation: Non-Union (100)
Work Schedule Monday - Friday 7:30 a.m. - 4:30 p.m. (flexible)


Position Summary

The Compliance Educator position develops, coordinates, and leads education and training programs to Park Nicollet Clinic (PNC) providers, professional coders and other billing and business services departments on compliant documentation, coding, and billing to ensure the organization meets all coding, state and federal compliance requirements. The incumbent researches, analyzes, and responds to inquiries regarding compliance, coding, third party payors, Medicare/Medicaid, denials, and billable services. A highly visible position with extensive provider interaction and this role acts proactively to minimize compliance risk. Other duties include coaching and mentoring new physicians and other credentialed practitioners in coding, billing, and documentation requirements, being a resource for clinic managers and finance (billing) regarding coding and documentation requirements, alerts managers regarding possible compliance problems, and researches regulatory questions with Third Party payers and communicates those answers to appropriate department representative. This position requires expertise in reviewing documentation and determining CPT/HCPCS and ICD-9 diagnosis/carrier coding and billing guidelines/regulations. The individual must be detail oriented, organized, work successfully both independently and on team projects, be able to problem solve effectively, establish credibility and rapport with leaders/staff in multiple disciplines within the organization, and have the willingness to actively remain updated and current with changes in the field. In addition, the individual in this role must consistently exhibit sensitivity, integrity, the ability to adapt and support change quickly, and embrace continuous learning. Additional minimum requirements include successful completion of a coding certificate program and two years of coding experience in a health care organization. Must obtain a RHIA, RHIT, or CPC certification (CCS-P and/or CCS) within 6 months of hire.

Monday, September 24, 2007

United Health Care Job Opportunities

Project Manager and Business Analyst job opportunities post at:
http://www.unitedhealthgroup.com//careers/search/regions/search_na.htm

2 current openings: 188443, 184842

If you currently have a degree or are close to receiving a degree, test the water and submit your resume! It will be a good experience.

Wednesday, September 19, 2007

classmate looking for position in health care

We have a classmate who would like to find an entry level job in health care while completing the HCM program. Positin in business office, HR, or administrative support at the entry level would be wonderful. If you are aware of an opening in your healthcare organization, let me know and I will pass it on to the student.

Tuesday, September 18, 2007

We need you as 'future thinkers' in health care

The future of health care talks about a 'sea of change' in the field. That means that what we know about health care today is obsolete. I want you to be 'future thinkers' in health care. One example would be: Health care could be outsourced to foreign countries due to the high costs of certain procedures?....Nursing homes in the U.S. currently charge between 3,000 and 4,000 dollars per month. You could live in a nursing home on a costal area of Mexico or Central or South America for 1,300 a month. Is this a viable option? You could have transplants or plastic surgery overseas for 1/3 the cost in the U.S. Is this really a viable option? Think about health care, as a health care manager, in GLOBAL TERMS. Interesting, isn't it.



UPDATE



Yesterday I received information from AARP that identifies Americans are going overseas for health care procedures due to insurance and costs. Two examples include a person from FL who went to Thailand for spinal stenosis surgery. The total bill was $4,618.03 for services that would have cost him at least $14,000 out of pocket at home. The person was so pleased with his care by a U.S. trained doctor at Bangkok’s “Bumrungrad International Medical Center” that he says he won’t seek medical care in the U.S. Another person had double by-pass surgery, said he was treated as a guest as well as a patient, and his surgery cost less than $17,000 and his insurance covered all but $3000. Stateside he estimates he would have had to pay up to $20,000 out of pocket.

He was one of an estimated 500,000 Americans treated abroad in 2006. As U.S. health costs have soared, ‘medical tourism’ has morphed in recent years from an obscure phenomenon into a global industry. Thailand remains a top destination, with Bumrungrad (a JCAHO accredited facility) alone treating over 64,000 Americans. Other countries that cater to foreign patients include Singapore, Hungary, South Africa, Dubai, Costa Rica and Brazil. A person from Alaska gave up their health insurance when premiums soared to over $1000 a month. Needing hip surgery at $40,000 to $60,000, the person used “Med Journeys” a health travel agency, and had the procedure completed including travel for $15,000, in New Delhi.



People are doing extensive research before committing to overseas medical care. Can health care be outsourced? Apparently it is occurring. We need health care managers who are committed to addressing the competition. Gosh, health care management careers are going to be fun…………..

Wednesday, September 12, 2007

HCM Blog site

Thank you David Binsfield, HCM Advisory Board Member for setting up the HCM blog site!!
Outstanding contribution to the program and outstanding, creative job!

Tuesday, September 4, 2007

Welcome to the MSB/Globe Health Care Management blog!

Welcome to the Minnesota School of Business/Globe University Health Care Management program blog. This resource has been created for students, faculty, staff and board to communicate to each other and share information on a variety of subjects. We are still in the construction phase but will soon be up an running so look for an email invitation to be part of this forum!