Position Summary:
The Business Analyst serves as liaison between business units and IT department to elicit, analyze, communicate, and validate requirements for changes to business processes, policies, and information systems. These key individual reviews, analyzes and evaluates business systems and user needs, including troubleshooting system integration issues, application and software issues and monitoring technology implementation initiatives in a regional area.
Essential Functions:
Provides connection between business owners and IT technical resources to initiate realistic solutions for contract requirements, workflows, and business needs.Participates in the design, development, and delivery of software applications training programs, coordinating closely with IT managers and non-technical business units to implement and define the support structure for business projects.Supports the Finance Manager in establishing joint, reusable, and shared strategic and tactical solutions. Collaborates with internal IT staff to coordinate delivery schedules and assure delivery of needed services and goods on time and within budget.Works closely with other departments to anticipate changes in functionality and priorities.Gathers and assesses strategic operational project status, issues, risks, and dependencies.Leads special projects in collaboration with interns. Complies with all guidelines established by the Centers for Medicare and Medicaid {CMS) and guidelines set forth by other regulatory agencies, where applicable. And all other duties assigned by the manager and/or supervisor.Education:
Bachelor's Degree in Information Technology, Business, Engineering, or related field .Experience:
Minimum 2 years of experience in project management and information systems; management of healthcare data preferred.Knowledge:
Knowledge and experience in Project Management.Personal computer experience should include working with Microsoft Word, Excel, Power Point, MS Visio, MS Project, and Outlook at the intermediate level at a minimum. SharePoint, SQL and other statistical software are desirable. Read Less
Position Summary:
The Billing Coordinator will follow up on unpaid claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement. Process and monitor incoming payments and secure revenue by verifying and posting receipts in compliance with financial policies and procedures.
Essential Functions:
Collect, post, and manage patient account payments.Submit claims, investigate rejected claims to see why denial was issued.Submit appeals and reconsiderations to insurance.Review delinquent accounts and call for collection purposes. Escalate problem accounts to Manager to obtain payment.Process payments from insurance companies.Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.Handle information about patient treatment, diagnosis, and related procedures to ensure proper coding.Reports possible instances of fraud and abuse, if found.Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.Provide training in billing practices.In addition, all other duties assigned by the manager and/or supervisor.Education:
Certified High School Diploma or equivalent.Experience:
Minimum 3 years experience in medical billing with billing or medical coding certification. Knowledge of insurance guidelines. Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursementKnowledge:
Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum. Experience in CPT and ICD-10 coding; familiarity with medical terminology. Know several different coding systems, including Level 1 HCPCS and Level 2 HCPCS. Read LessResumen del puesto:
El Analista de Negocio sirve de enlace entre las unidades de negocio y el departamento de TI para obtener, analizar, comunicar y validar los requisitos para los cambios en los procesos de negocio, políticas y sistemas de información. Esta persona clave revisa, analiza y evalúa los sistemas empresariales y las necesidades de los usuarios, incluida la resolución de problemas de integración de sistemas, problemas de aplicaciones y software y la supervisión de iniciativas de implementación de tecnología en un área regional.
Funciones esenciales:
Proporciona conexión entre los propietarios de negocios y los recursos técnicos de TI para iniciar soluciones realistas para los requisitos contractuales, flujos de trabajo y necesidades empresariales.Participa en el diseño, desarrollo e impartición de programas de formación sobre aplicaciones informáticas, coordinándose estrechamente con los responsables de TI y las unidades empresariales no técnicas para implantar y definir la estructura de apoyo a los proyectos empresariales.Apoya al Director Financiero en el establecimiento de soluciones estratégicas y tácticas conjuntas, reutilizables y compartidas. Colabora con el personal interno de TI para coordinar los calendarios de entrega y garantizar la prestación de los servicios y bienes necesarios a tiempo y dentro del presupuesto.Trabaja en estrecha colaboración con otros departamentos para anticiparse a los cambios de funcionalidad y prioridades.Recopila y evalúa el estado, los problemas, los riesgos y las dependencias de los proyectos operativos estratégicos.Dirige proyectos especiales en colaboración con los becarios. Cumple todas las directrices establecidas por los Centros de Medicare y Medicaid {CMS) y las directrices establecidas por otros organismos reguladores, en su caso. Y todas las demás funciones asignadas por el gerente y/o el supervisor.Educación:
Bachillerato en Tecnología de la Información, Negocios, Ingeniería o campo relacionado .Experiencia:
Mínimo 2 años de experiencia en gestión de proyectos y sistemas de información; preferiblemente en gestión de datos sanitarios.Conocimientos:
Conocimientos y experiencia en gestión de proyectos.La experiencia en informática personal debe incluir el trabajo con Microsoft Word, Excel, Power Point, MS Visio, MS Project y Outlook a nivel intermedio como mínimo. Son deseables SharePoint, SQL y otros programas estadísticos. Read LessPosition Summary:
The HP3- Social Worker (TS) provides immediate assessment and assistance for patients at the clinic. This key individual must make quick determinations to manage a crisis and properly channel a course of treatment. The HP3- Social Worker (TS) participates of the patients’ family matters and identifies social limitations that might affect treatment. The HP3- Social Worker (TS) coordinates with communitarian agencies for other services that could be needed for patient treatment.
Essential Functions:
1. Evaluates patients through interviews and gathers clinic, social and health information necessary for effective analysis. Advises patients about rights, responsibilities, treatment consents and proper actions. Full time employees must evaluate a minimum of 14 patients per day; Part time employees must evaluate a minimum of 8 patients per day.
2. Analyses, plans, develop and administer patient treatments focusing on patient’s wellbeing and participation. Offers individual, family and group therapy, considering actions that effectively benefit the patient and provides support.
3. Revises and monitors treatment plan and prioritizes courses of action. Considers factors that could affect treatment and consults with other professionals in order to assure the patients wellbeing.
4. Refer and coordinates with communitarian agencies for services that benefit and are convenient for treatment. Offers workshops and educational talks to beneficiaries APS Healthcare patients in open waiting room.
5. Collaborates with hospitalization when necessary; revises patients under Intensive Management Program (Clinic Level) for high utilization.
6. Promotes and participates in case discussions to multi and interdisciplinary teams, as well as interagency level.
7. Responsible for monthly calendar for case discussion with providers, agencies or others; Completes necessary reports for agencies according to social needs.
8. Documents attendance and interventions in the patient file and keeps them in a safe, confidential area.
9. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable; Complies with regulatory patient waiting time of no more than 1 hour, as established by law.
10. And all other duties assigned by the manager and/or supervisor.
Education:
• Master’s degree in Clinic Social Work.
• Must have current, unrestricted license to practice in the Puerto Rico territory and Professional College Membership.
Experience:
• Minimum 2+ years of experience in the mental health field of related.
Knowledge:
• Knowledge of the mental health law; Law 408.
• Must demonstrate extensive knowledge of the laws that protect services for children, elderly people, persons with special needs (Special Education), persons with disabilities, mental health patients, family relations and legal and remedies for compulsory admission to rehabilitation’s programs.
• Knowledge of the DSMV, diagnosis and pharmacology.
• Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Position Summary:
The Facility Coordinator performs daily activities related to the Facilities Department such as facilities’ inspections, mail sorting and distribution, preparation of outgoing mail and merchandise, delivery of equipment, inventory tracking and upkeep, merchandise receiving, and employee assistance.
Essential Functions:
Performs daily purchasing of newspapers.Receives and delivers mail at central office; performs daily UPS pre-pricing shipping.Receives merchandise from vendors; prepares and coordinates delivery of merchandise for clinics and central office.Provides messenger services as needed.Equipment inventory custodial; takes inventory of paper and coffee supplies at central office.Performs weekly document pick up at the assigned client facility.Conducts daily inspections of facilities and reports findings; receives claims on a daily basis and documents on log.Assist all employees with facility and purchasing related needs.Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.In addition, all other duties assigned by the manager and/or supervisor.Education:
High School Diploma.Current, unrestricted driver’s license.Experience:
Minimum 1 year of experience in equivalent position.Knowledge:
Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.Resumen del Puesto:
El Coordinador de Facilidades realiza actividades diarias relacionadas con el Departamento de Facilidades, tales como inspecciones de las instalaciones, clasificación y distribución de correo, preparación de correo y mercancía para envío, entrega de equipos, seguimiento y mantenimiento de inventarios, recibo de mercancía y asistencia a empleados.
Funciones Esenciales:
Realiza la compra diaria de periódicos.
Recibe y entrega el correo en la oficina central; realiza el pre‑precio diario de envíos UPS.
Recibe mercancía de suplidores; prepara y coordina la entrega de mercancía para las clínicas y la oficina central.
Ofrece servicios de mensajería según sea necesario.
Custodia el inventario de equipos; toma inventario de papel y suministros de café en la oficina central.
Realiza la recogida semanal de documentos en la facilidad del cliente asignado.
Lleva a cabo inspecciones diarias de las instalaciones y reporta hallazgos; recibe reclamaciones diariamente y las documenta en el registro.
Asiste a todos los empleados con necesidades relacionadas a facilidades y compras.
Cumple con todas las guías establecidas por los Centros de Medicare y Medicaid (CMS) y otras agencias reguladoras aplicables.
Realiza todas las demás tareas asignadas por el gerente y/o supervisor.
Educación:
Diploma de Escuela Superior.Licencia de conducir vigente y sin restricciones.Experiencia:
Mínimo1 año de experiencia en un puesto equivalente.Conocimientos:
Experiencia en computadoras, incluyendo manejo de Microsoft Word, Excel, PowerPoint y Outlook a nivel intermedio como mínimo.Position Summary:
The Health Professional 1-Pharmacy Call Center Representative manages telephone calls from pharmacies and providers related to pharmacy benefits, authorization requests, drug use review, among others, to ensure that claims are correctly and timely adjudicated.
Essential Functions:
1. Answers and manages telephone calls from pharmacies and providers in a timely, confidential and courteous manner.
2. Documents calls and/or drug requests with complete follow-up history of the patient through electronic records.
3. Provides orientation to pharmacies regarding pharmacy benefits.
4. Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are
correctly adjudicated.
5. Assists pharmacies claim processing.
6. Assist in the training of pharmacy representatives.
7. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
8. In addition, all other duties assigned by the manager and/or supervisor.
Education:
Pharmacy Technician Course of accredited school.Possess an active professional unrestricted Pharmacy Technician License in good standing to practice in Puerto RicoExperience:
· Minimum 2 years’ experience in retail pharmacy preferred.
Knowledge:
· Basic knowledge of physical and mental pharmacotherapies, in order to make accurate assessments of clinical cases.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
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