Administrative Specialist II / BPH C&A / HIS Insurance

State of South Carolina • Richland County, SC

3d • 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, applies the policies and procedures of the Medicare/MedicaidfI'ri= and third-party programs for inpatient alcohol/drug and psychiatric services. Determines patient's eligibility imder Medicare/Medicaid/I'ricare and prepares forms. Assists the Utilization Review Nurse by providing all insurance information timely and making the required pre-certification calls w 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 walk to patient areas and travel between campuses.
• 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/fricare 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 ME Cs at least weekly, to obtain such information.
• Regarding emergency admissions, ensures that the Medicaid CONs are completed by the BPH C&A Treatment Team.
• Works 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 emails 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