CCSWW

  • Data Management Specialist II

    Job Locations US-OR-Portland
    Posted Date 4 weeks ago(5/24/2018 7:38 PM)
    Job ID
    2018-3090
    # of Openings
    1
    Category
    Behavioral Health
    Min
    USD $18.36/Hr.
  • Overview

    This position is responsible for a high volume of medical insurance claims management for several contracts out of the Portland, Oregon office.  Primary responsibilities include managing authorizations, monitoring eligibility, ensuring funding and authorization lids are adequate for services rendered, detailed denial research, working with several funders to reprocess varying claims and developing procedures and checks to ensure all aspects of processing are complete, and assist with contract-specific data entry. This position works under the direction of the Oregon Clinical Quality Improvement and Compliance Manager.

    Responsibilities

    • Ensures coverage and authorizations are in place with private and public funding agencies on high volume of new referrals and ongoing cases using MMIS, CIM3 (HSO), Optum Provider Express (UBH), and One Health Port (other private insurance). This may include fax, phone calls, emails, or meetings with funding agencies.
    • Sets up authorizations lids in PsychConsult system to ensure claims are billed below payment levels.
    • Sets up coverage in PsychConsult using information found in MMIS, CIM3 (HSO), Optum Provider Express (UBH), and One Health Port (other private insurance) to create claims for clinical transactions.
    • Enter high volume of enrollment and discharge data into MOTS (Measures and Outcomes Tracking System) for all clients with OHP (Oregon Health Plan) coverage.
    • Completes retroactive changes in coverage for consumer reprocessing through PHTech.
    • Evaluate and resolve data errors in PsychConsult batch error handler.
    • Monitor high volume of EOBs (explanation of benefits) for denied claims in MMIS, CIM3 (HSO), Optum Provider Express (UBH), and One Health Port (other private insurance). Assertively re-work claims through successful payment.
    • Evaluate and resolve high volume of complex outstanding Accounts Receivable for Oregon office by coordinating with Oregon and Washington CCS staff members as well as Oregon funders.
    • Determines which claims are deemed uncollectible and eligible for write off.
    • Communicates with the Oregon Site Director and FBH Business Manager for approval on all uncollectible claims before sending them to the Accounting Office for writing off.
    • Collaborates with Clinical Quality Improvement and Compliance Manager in providing staff training on coding, billing per new contract requirements.
    • Participates on Coordinated Care Organizations and County billing groups.
    • Develops and maintain relationships with CCO, County, and private insurance contact persons for data and claim management functions.
    • Back up support for all tasks assigned to Data Management Specialist and Records Custodian.

    Qualifications

     

    • High School Diploma or equivalent.
    • One or more years of data entry and claims management experience.
    • Three or more years’ experience working in an office setting.
    • Strong computer skills especially in Outlook, Word, Excel and Access.
    • Excellent verbal and written communication skills, including the ability to provide high quality customer service.
    • Excellent organizational skills and ability to work in a busy and diverse environment.
    • Pass background checks through DHS and OR State Patrol.
    • Availability to work flexible hours (daytime business hours only).
    • Ability to work both independently and as a member of a team. 
    • Support and uphold the mission, beliefs and values of Catholic Community Services and Catholic Housing Services.
    • Demonstrates the necessary attitudes, knowledge and skills to deliver culturally competent services and work effectively in multi-cultural situations.

     

    PREFERRED QUALIFICATIONS:

    • Experience with Electronic Health Records (EHR’s), such as Epic or other commonly used healthcare information software programs.
    • Experience with medical coding.
    • Knowledge of medical insurance claims management procedures and verbiage.
    • Ability to analyze consumer data and make recommendations.
    • Experience with business writing.
    • Knowledge of accounting principles

     

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