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DESCRIPTION 

Decypher is seeking a Administrative Assistant- Appointment Line to support the mission at Lakenhealth, UK. 

Duties and Responsibilities 

The Contractor shall provide MRASC who engage with patients through phones and electronic means to answer/place calls and answer/place electronic messages for the 48 MDG, RAF Lakenheath, in both specialty appointing, primary care appointments and/or referral management. Referral management will be required assist walk in customers with referrals.

The MRASC will assume centralized specialty appointing (approximately 6,200 calls per month), primary care appointing (approximately 7,200 calls per month) and referral management (1,100 referrals per month). 5.2. The MRASC will perform within one or more of the following business lanes: Appointing Management or Consult Management with regard to primary and specialty care

 MRASC s shall utilize the Automated Call Distribution (ACD) system and TRICARE Online Patient Portal Secure Messaging In Accordance With (IAW) established protocols and where applicable, use Standard Operating Procedures (SOPs), Booking Protocols, and Business Rules in combination with developed skill sets in the execution of the MTF mission

. The MRASCs shall meet or exceed the required metrics in accordance with Air Force Instruction (AFI) 44-176, dated 8 September 2017. DoD, DHA, AF and MTF policies & instructions.

 MRASCs shall handle inbound ACD routed calls with each average handle/transaction time per month of less than or equal to one hundred and eighty (180) seconds per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds.

. MRASCs shall answer 90 percent (90%) of all inbound ACD routed calls with each average answer time per month at ninety (90) seconds This metric is known as Service Level. No individual day or hour average shall go below 75 percent (75%).

. MRASCs shall handle inbound ACD routed calls with each average speed of answer per month of less than or equal to 45 seconds per call. No individual day or hour average shall exceed ninety (90) seconds.

MRASCs shall manage inbound ACD routed calls to prevent calls from being dropped. Dropped calls shall not exceed, 8 percent (8%) of all answered calls. No individual day or hour average shall exceed 15 percent (15%) seconds. 5.8. MRASCs shall record 100 percent (100%) of all inbound ACD routed calls.

 MRASCs shall make outbound calls with each clerk’s average handle/transaction time per month, of less than or equal to one hundred and eighty (180) seconds per call. No individual day or hour average shall exceed two hundred and seventy (270) seconds.

. MRASCs shall utilize the Composite Health Care System (CHCS) Managed Care Program Module, Assignment Order Processing Module, or any Air Force mandated system(s), to identify appointment availability, schedule, cancel, and reschedule appointments for 48 MDG and 501 CSW, following local directives, established protocols, Booking Protocols, and the MTF Business Rules using the appropriate Access to Care (ATC) category, matched to the appropriate standard appointment types, and detail codes within the appropriate ATC standards. 17

MRASCs will generate or receive, and electronically deliver, telephone messages (t-cons) to medical providers and clinic support staff by using CHCS or AHLTA, or any Air Force mandated system(s), per individual clinic guidelines; AFI 44-176, dated 8 September 2017; and any other applicable DoD, DHA, AF, and MTF policies & instructions.

 MRASCs shall take the following actions concerning specialty care consults/referrals:

 MRASCs shall disposition referrals as “Appoint to applicable MTF, RAF Lakenheath, RAF Alconbury, and RAF Croughton” or “Defer to Network” within one (1) business day of receipt in accordance with Air Force Instruction (AFI) 44-176, dated 8 September 2017, and the DHA Interim Procedures Memorandum 17-002 dated 19 Jan 17. DoD, DHA, AF and MTF policies & instructions.

MRASCs shall review referrals for administrative completeness, covered TRICARE benefit and required tests and pre-work. Coordinates with referring providers in cases where additional referral information is required.

MRASCs will book specialty care consults/referrals when contacted by the patient and the referral is dispositioned as “Appoint to RAF Lakenheath MTF. If the referral is dispositioned as RAF Alconbury or RAF Croughton, the MRASCs will transfer the call to the appropriate referral line.” If the referral lacks a review disposition when the patient calls, then the MRASC will provide a “warm hand-off” to the specialty clinic to immediately review the referral and appoint or defer it.

MRASCs will proactively contact patients with active specialty referrals until the specialty or behavioral health care appointment can be booked, the patient cancels the referral, or the message has been delivered three (3) times (first message NLT day 3 and final message NET day 14). Each contact attempt will be documented in CHCS or any Air Force mandated system(s).

When the MTF cannot offer three (3) different appointments within the access to care standard, the MRASC will inform the patient that the specialty referral can be deferred to the network and will offer the patient an MTF appointment outside the standard. The MRASC will process the specialty referral according to the patient’s preference.

MRASCs shall assist with ROFR determinations for specialty care that can be provided within the MTF using Service Availability (Capability) Listings and information systems that link the referral to the appointment to the ATC category and standard. ROFR shall be processed within the time limits outlined in the TRICARE Operations Manual, Chapter 8, Section 5.

.MRASCs shall perform/assist with appointing network specialty care referrals as allowed by the TRICARE Overseas Program (TOP) Contractor

MRASCs will administratively close all un-appointed referrals accepted by the MTF NLT 180 days beyond the order date.

MRASCs shall manage the “cancellation line” feature, ensuring that when patients call in to cancel appointments by leaving voice mail, the MRASC shall 60 message and go into AHLTA/CHCS, or any Air Force mandated system(s), to cancel the applicable appointment within same day or coordinate with the appropriate clinic to get the appointment cancelled within the same day. 5.22. When patients request to cancel a specialty referral appointment or consult, MRASCs will document the cancellation reason in CHCS, or any Air Force mandated system(s), and send a t-con to the 18 referring provider within one (1) business day of the cancellation. No individual weekly timeliness average of cancellation notifications will exceed two (2) business days.

MRASCs shall verify beneficiary eligibility, using patient’s DOD ID number and two (2) patient identifiers, refer patient to DEERS and update patient demographics in CHCS per DoD Healthcare policy, and local MTF policies.

.MRASCs will attend all training activities, per local MTF policies. Training may include but is not limited to topics designed to increase skills, enhance workflow or communication, update on standard operating procedures, adjust to changing mission requirements, address facility or installation issues or increase overall effectiveness and efficiency of operations.

Contract personnel will provide Phase I (didactic/classroom), Phase II (over-the- shoulder/on the floor), and Phase III (specialty consult) training to all contract personnel at a level of excellence commensurate with training provided to civil service personnel.

Contract personnel will also provide training to Active Duty/Civilian/Red Cross volunteers who have been identified to support the MRASCs, when deemed necessary for times when the contract company does not/cannot provider the required personnel to meet contract requirements.

Contract personnel shall complete all required training within the first month of assignment and be able to perform all functions required for the MRASC.

MRASCs will provide patients with specific instructions for their appointment/referral following local directives, established protocols, SOPs, Booking Protocols, and the MTF Business Rule

MRASCs will perform other administrative and clerical duties in support of the medical care and operational support as required.

MRASCs will advise patients of the provider, location, time and day of their booked appointments. MRASCs will coordinate with specialty referral clinics (e.g., internal MTF, Veteran’s Affairs clinic, etc.) on special patient instructions and tests required prior to appointment.

.MRASCs will track initial specialty care and deferred to network primary care referrals to include obtaining reports from MTF, network, and non-network providers. The primary responsibility to obtain Network and purchased care results will be with the MTF.

.MRASCs will process initial specialty care and deferred to network primary care reports in the HAIMS following the business rules outlined in AFI 44-176, dated 8 September 2017, DoD, DHA, AF and MTF policies & instructions, close the specialty referral in CHCS, and send a t-con to the referring provider or PCM within three (3) days of receipt of the report. No individual weekly timeliness average of network report notifications will exceed five (5) business days.

.MRASCs will initiate efforts to capture network reports upon request of the referring provider or no later than 60 days from the date the specialty referral was ordered or as soon as a claim is 19 discovered, whichever occurs first.

When a CLR has not been received or documented in the EHR, the RMC will check the applicable claims database for a claim.

If a claim is found, the RMC will request the CLR from the rendering purchased care provider. If there is no response from the provider within 10 calendar days, repeat. If the provider still does not provide the CLR, the RMC will close the referral in CHCS using the status of “Deferred results received” and annotate {CRNRR} in soft brackets in the CHCS Review Comment Field indicating a claim was reported but no results were received. Notify the referring provider. Initiate TRICARE contractor procedures as per the TOM and/or the Memorandum of Understanding (MOU) with the TRICARE regional contractor. Additionally, forward a report to the TRICARE Regional Office each month that lists all provider names, specialty care rendered, and referral Unique Identifier Numbers for which no CLR has been received after two attempts or per MOU. Per AFI 44-176, Business Rule #21.1 and 21.2

.MRASCs will administratively close all open specialty referrals deferred to the network NLT 180 days beyond the order date.

. MRASCs will pull NAL reports and enter them into AHLTA under the appropriate clinic.

MRASCs will use TOL Patient Portal Secure messaging to:

.Register beneficiaries for TOL Patient Portal Secure Messaging Accounts IAW established protocols.

.Out-process beneficiaries from TOL Patient Portal Secure Messaging when the member PCSs, separates, retires, or any other reason where the member no longer needs access to the system.

Communicate with beneficiaries for scheduling appointments or concerning the use/activation of referrals.

Answers main office phone line(s). Directs telephone calls to appropriate section for assistance, handles independently or takes messages as required.

Reviews referrals for administrative completeness and researches covered benefits prior to processing.

Determines patient eligibility for services and arranges and schedules medical appointments for referred care.

.Provides general instructions to patients and ensures patients have necessary documentation for referred health care services.

 Obtains updates and files medical records as needed.

.Organizes and researches patient records, extract needed information, and review records for referral within established guidelines.

 Request medical records and ensures arrival of medical records prior to appointment(s). 

 Initiates and locates patient medical records as needed.

Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records).

.Ensures referral results are returned to the referring provide and to the medical record within required timelines. Assists with follow up, written or verbal, as necessary.

Utilizes the referral tracking data collection tool. Calculates metrics, and compiles monthly reports, as directed by the MTF.

. Orients and trains MTF personnel about the referral process and timelines.

Qualifications:

Mandatory Knowledge and Skills:

•  A fully qualified typist (computer keyboard) with a minimum of 50 Words per Minute is required.
•  General office administrative and clerical skills to perform receptionist duties and answer telephones.  Standard office equipment, such as personal computers, copiers, fax machines, and telephone systems. .
• An understanding of general medical ethics, telephone etiquette, and excellent communication, to be able to actively convey information through the exchange of thoughts, messages, or information, by speech or writing, with excellent customer service skills, a professional demeanor, appropriate interaction with clients and able to promote the best image of the government.
• Able to read, write, and speak English well and should not suffer from any reading, writing, speaking or hearing limitations, so as to ensure effective communication with customers on the phone
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Education: 

• Administrative personnel shall possess a high school diploma or General Educational Development equivalency. Completion of administrative assistant program is desirable

Experience:

• . At least six (6) months of experience in medical office doing scheduling or referral management. Customer Service Training/experience.
• Contract personnel basic knowledge and skill level includes: principles of excellent customer service; TRICARE benefits; quality control and risk management; medical terminology, medical forms and records management; HIPAA guidelines for release of medical information; general medical and legal ethics; excellent communications skills; strong organizational skills; and computer operations, including operational skills with Microsoft applications (Windows Operating system, Microsoft Word, Microsoft Access, and Excel,); personnel shall understand the importance of meeting deadlines. Knowledge of current ICD- 10 (International Classification of Diseases, tenth revision) coding desirable, but not required.
• The Contractor personnel shall have functioning knowledge of Government appointing MHS Guide to Access Success and referral management business rules (AFMS RMC Guide), Government appointing information systems, DHA, TJC or AAAHC, UEI, HIPAA, DoD Health Information Privacy Regulation (DoD 6025.18-R), the Privacy Act, and DoD Privacy Program (DoD 5400.11- R). The Contractor shall ensure that their staff has read the current AFMS RMC User Guide prior to start of work.

Certifications:

• BLS