HUMAN SERVICES PROGRAM ANALYST - 64030726

State of Florida • Saint Petersburg, FL

8d • $40,780 - $45,000 • Onsite

About The Position

This position is an Analyst within the Specialty Care Program, whose primary functions are to generate medical referrals for specialists in the Pinellas County Health and Health Care for the Homeless Plans. The primary duties involve referral generation, including evaluating services for cost-effectiveness and quality, authorizing services based on medical necessity, verifying county eligibility, and generating authorization referrals in accordance with established procedural guidelines. The role also includes data review, ensuring accuracy in data entry, assisting in guideline development, and liaising with specialist providers. Indirect services and other duties include backing up the DOH pharmacy tech, accessing pharmacy voicemails, using the portal information center, scanning and importing medical records, participating in quality improvement activities, faxing referrals and medical records, submitting employee activities reports, and entering services and processing billing claims.

Requirements

• Knowledge of medical terminology.
• Knowledge of Pinellas County Health and Health Care for the Homeless Plans.
• Ability to plan, organize and coordinate work assignments.
• Ability to establish and maintain working relationships with others.
• Ability to type and/or in a keyboard control data input device and utilize other office equipment.
• Ability to follow instructions.
• Ability to review data for accuracy and completeness.
• Ability to meet and maintain minimum production requirements for speed and accuracy.
• Ability to communicate effectively both written and verbal.
• Skills in Information Technology.
• 3+ years’ Experience in a Health Care and / or a Clinical Setting
• At least 1 years’ experience with Advanced skills in Information Technology
• 3+ years Knowledge and Understanding of Medical Terminology and standard abbreviations
• Must be able to learn and communicate effectively, orally and in writing, in English.

Nice To Haves

• Medical Licensure
• Bachelor’s Degree

Responsibilities

• Evaluates services to achieve and maintain cost effectiveness, quality health care.
• Limits services based on medical necessity and procedural guidelines.
• Uses professional guidelines for Specialty Care.
• Develops procedures to evaluate medical necessity.
• Evaluates authorization requests for specialty care referrals in accordance to the established Specialty Care medical grid (Radiology, and other specialties).
• Verifies County eligibility.
• Generates authorization referrals for Specialty Care in accordance with established procedural guidelines in Athena EMR.
• Generates 15 Referrals daily or meets center capacity demand.
• Generates letters as needed.
• Faxes referrals to medical providers as needed.
• Processes stat referrals as assigned.
• Verify data requested from source documents is entered with a 95% accuracy rate.
• Assist the Business Operations Specialist in the development and implementation of guidelines to be used for consistent application of criteria.
• Liaisons with specialist providers requesting additional medical information as needed.
• Backs up DOH pharmacy tech to provide pharmacy services to PCHP clients as assigned, to include overrides/prior authorizations or denials.
• Access pharmacy voicemails and phone calls from medical providers as needed.
• Use portal information center.
• Scans and imports medical records in accordance established standards.
• Participates in quality improvement activities, including chart review, in-service programs, and staff meetings.
• Faxes Referrals and medical records to providers.
• Submits employee activities report (EARS) in a timely manner.
• Enter services and process billing claims.

Benefits

• Annual and Sick Leave benefits
• Nine paid holidays and one Personal Holiday each year
• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options
• Retirement plan options, including employer contributions
• Flexible Spending Accounts
• Tuition waivers

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level