Administrative Specialist II / BPH C&A / HIS Insurance

State of South Carolina • Richland County, SC

6d • Onsite

About The Position

This position is located at the SC Department of Behavioral Health and Developmental Disabilities (DBHDD) - Office of Mental Health– Inpatient Services, 220 Faison Drive, Columbia, SC 29203. As the Administrative Specialist II, working under general supervision, you will apply the policies and procedures of the Medicare/Medicaid/Tricare and third-party programs for inpatient alcohol/drug and psychiatric services. Determine patient's eligibility under Medicare/Medicaid/Tricare and prepare forms. Assist the Utilization Review Nurse by providing all insurance information timely and making the required pre-certification calls to insurance companies within the required time period. Serves as contact person for C-213.

Requirements

• A high school diploma or GED.
• Must be able to administer and follow guidelines of Medicare/Medicaid/Tricare programs.
• Maintain a high level of confidentiality when releasing information.
• Apply judgement regarding the operation of the area.
• Be aware an employee in this position is considered essential.

Nice To Haves

• Associates degree in secretarial science or other related field or a high school diploma with two (2) years of experience, of which one (1) year is in Medicare/Medicaid/Tricare.
• Bilingual abilities in English and Spanish (or another language) are a plus.

Responsibilities

• Uses different computer systems to determine and verify Medicare/Medicaid/Tricare and third-party eligibility on all patients.
• Interview patients upon admission regarding insurance coverage.
• Enters the financial eligibility into Avatar.
• Obtain and maintain authorizations for release of medical information from patient and/or policy holders.
• Notify UR Nurse of all insurance and makes pre-certification contacts within the required time frames.
• Trouble shoot and investigate insurances for Reimbursement/Billing.
• Keep abreast of changing federal regulations governing the Medicare/Medicaid/Tricare Programs.
• Contact the mental health centers (MHC) when necessary, to obtain a Medicaid CON for urgent and voluntary admissions as well as a 257 and the Emergency Concurrence forms within one working date, following admission.
• Follow-up with the MHCs at least weekly, to obtain such information.
• Regarding emergency admissions, ensure that the Medicaid CONs are completed by the BPH C&A Treatment Team.
• Work closely with the OMH Reimbursement Staff; providing them with the above-mentioned forms and other necessary insurance information.
• Prepare correspondence for insurance companies to include sending copies of required records to Reimbursement, for retrospective reviews and appeals.
• Complete the morning report on all insurances identified for that day and email the report to the UR nurse and other appropriate staff as required, by 1:00 p.m.
• Maintain compliance with Corporate Compliance, Harassment-Free Workplace policies, Time and Attendance policies and facilities requirements for cultural awareness training.

Benefits

• Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children.
• 15 days annual (vacation) leave per year
• 15 days sick leave per year
• 13 paid holidays
• Paid Parental Leave
• S.C. Deferred Compensation Program available
• Retirement benefit choices
• State Retirement Plan (SCRS)
• State Optional Retirement Program (State ORP)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED