Title: Data Claims Management Specialist Date Open: 8/21/15 Date Closed: 8/31/15
Department:
Family Preservation - Portland Reports to: Operations Manager
Status:
Full time with Benefits FLSA: Non-exempt Starting Salary/Hourly Rate:
Program
Description:
The Family Preservation System provides an integrated and flexible array of strengths-based services and supports centered around one predominant belief: Children need their families and families need their children. All services are delivered with the following core values in mind: safety of the child, family and community; flexible and responsive; family driven; normative; family oriented; strengths based; comprehensive and collaborative; unconditional; individualized; and culturally relevant.
Position
Description:
The Data Claims Management Specialist position is responsible for data and claims management for contracts out of the Portland, Oregon office. Primary responsibilities include entering data, ensuring private insurance and Medicaid funding and authorization lids are adequate for services rendered. Position also requires working with funders to process denials and develop procedures to ensure data is timely, complete and accurate.
Essential
Functions: * Make timely and accurate data input into the database, including set up of new consumers and employees, consumer services and consumer exits. Assist leadership in preserving data integrity for audit purposes. * Utilize State mandated outcome system (MOTS) at entry and exit of client. * Verify data input and make appropriate corrections. * Perform monthly certification of data within contract parameters and reach out to appropriate funder for extensions or closure * Recommend and participate in implementation of reporting and database management changes. * Develop and distribute reports to leadership, both routine and adhoc, including staff activity, consumer outcome and service reports. * Track consumers by service type at intake and exit using current data collection system * Support Quality Management with the collection and processing of information for internal and external stakeholders, such as satisfaction surveys, outcome information, etc. * Completes reports including practitioner and access according to funder’s criteria. * Ensures coverage & authorizations are in place with funding agencies on new referrals and ongoing cases. This may include phone calls, emails, or meetings with funding agencies. * Sets up authorizations lids in PsychConsult system so claims are not above payment levels. * Sets up coverage in Psych Consult for submission of claims for clinical transactions and ensure coverage in MMIS and CIM. * Complete retro changes when patient coverage changes; complete rebills to the new coverage
* Reviews denied claims on a monthly basis to determine errors, requests correction and continues to follow up until corrected. * Determines which claims deemed uncollectible and that need writing off. * Communicates with the Oregon Director for approval on all uncollectible claims before sending them to the Accounting Office for writing off. * Collaborates with Operations Manager in providing staff training on coding, billing per contract requirements * Completes invoice as needed for contract payment. * Participates on funder’s billing groups as needed * Develops and maintain relationships with contacts at funders for data and claim management functions. * Other duties as assigned.
Job
Requirements:
* High School Diploma or equivalent. * Three or more years’ experience working in an office setting with at least one or more years of data entry experience. * Experience with electronic medical records, medical billing systems. * Demonstrated ability to function as a member of a team. * Knowledge of contemporary office software including Microsoft products: Word, Excel, Outlook. * Verbal and written communication skills to collaborate with staff, supervisors and funders in professional manner. * Must have an acceptable driving record per CCS’ driving policy (required to provide current driving abstract). * Applicant must successfully pass required background clearances prior to an offer of employment. * 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 * Support and contribute to a creative, collaborative and respectful environment that promotes teamwork. Preferred Qualifications: * Ability to analyze data and make recommendations for solutions. * Knowledge of accounting principles. * Ease with navigating online databases. * Intermediate experience with Microsoft Excel and Word.
Catholic Community Services and Catholic Housing Services is an Equal Opportunity Employer.
Please let us know if you need special accommodations to apply or interview for this position.
APPLICATION PROCEDURE: Please go to https://careers-ccsww.icims.com/
to submit your resume, cover letter and application for this position.
Department:
Family Preservation - Portland Reports to: Operations Manager
Status:
Full time with Benefits FLSA: Non-exempt Starting Salary/Hourly Rate:
Program
Description:
The Family Preservation System provides an integrated and flexible array of strengths-based services and supports centered around one predominant belief: Children need their families and families need their children. All services are delivered with the following core values in mind: safety of the child, family and community; flexible and responsive; family driven; normative; family oriented; strengths based; comprehensive and collaborative; unconditional; individualized; and culturally relevant.
Position
Description:
The Data Claims Management Specialist position is responsible for data and claims management for contracts out of the Portland, Oregon office. Primary responsibilities include entering data, ensuring private insurance and Medicaid funding and authorization lids are adequate for services rendered. Position also requires working with funders to process denials and develop procedures to ensure data is timely, complete and accurate.
Essential
Functions: * Make timely and accurate data input into the database, including set up of new consumers and employees, consumer services and consumer exits. Assist leadership in preserving data integrity for audit purposes. * Utilize State mandated outcome system (MOTS) at entry and exit of client. * Verify data input and make appropriate corrections. * Perform monthly certification of data within contract parameters and reach out to appropriate funder for extensions or closure * Recommend and participate in implementation of reporting and database management changes. * Develop and distribute reports to leadership, both routine and adhoc, including staff activity, consumer outcome and service reports. * Track consumers by service type at intake and exit using current data collection system * Support Quality Management with the collection and processing of information for internal and external stakeholders, such as satisfaction surveys, outcome information, etc. * Completes reports including practitioner and access according to funder’s criteria. * Ensures coverage & authorizations are in place with funding agencies on new referrals and ongoing cases. This may include phone calls, emails, or meetings with funding agencies. * Sets up authorizations lids in PsychConsult system so claims are not above payment levels. * Sets up coverage in Psych Consult for submission of claims for clinical transactions and ensure coverage in MMIS and CIM. * Complete retro changes when patient coverage changes; complete rebills to the new coverage
* Reviews denied claims on a monthly basis to determine errors, requests correction and continues to follow up until corrected. * Determines which claims deemed uncollectible and that need writing off. * Communicates with the Oregon Director for approval on all uncollectible claims before sending them to the Accounting Office for writing off. * Collaborates with Operations Manager in providing staff training on coding, billing per contract requirements * Completes invoice as needed for contract payment. * Participates on funder’s billing groups as needed * Develops and maintain relationships with contacts at funders for data and claim management functions. * Other duties as assigned.
Job
Requirements:
* High School Diploma or equivalent. * Three or more years’ experience working in an office setting with at least one or more years of data entry experience. * Experience with electronic medical records, medical billing systems. * Demonstrated ability to function as a member of a team. * Knowledge of contemporary office software including Microsoft products: Word, Excel, Outlook. * Verbal and written communication skills to collaborate with staff, supervisors and funders in professional manner. * Must have an acceptable driving record per CCS’ driving policy (required to provide current driving abstract). * Applicant must successfully pass required background clearances prior to an offer of employment. * 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 * Support and contribute to a creative, collaborative and respectful environment that promotes teamwork. Preferred Qualifications: * Ability to analyze data and make recommendations for solutions. * Knowledge of accounting principles. * Ease with navigating online databases. * Intermediate experience with Microsoft Excel and Word.
Catholic Community Services and Catholic Housing Services is an Equal Opportunity Employer.
Please let us know if you need special accommodations to apply or interview for this position.
APPLICATION PROCEDURE: Please go to https://careers-ccsww.icims.com/
to submit your resume, cover letter and application for this position.
