HUMAN SERVICES PROGRAM ANALYST - 64004525 1
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. Primary Duties : Referral Generation Evaluates services to achieve and maintain cost effective, quality health care. Authorized to limit 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, Behavioral and other specialties) Verifies County eligibility. Generates authorization referrals for Specialty Care in accordance with established procedural guidelines in HMS ACG. 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. Data Review Verify data requested from source documents is entered with a 95% accuracy rate. Review statistical reports in Logi. 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. INDIRECT SERVICES AND OTHER DUTIES 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. Enters Services and tracking process for Directions Behavioral Health program, review clinical notes match claims and authorization.
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 year experince with Advanced skills in Information Technology
- 5+ years Knowledge and Understanding of Medical Terminology and standard abbreviations
Nice To Haves
- Medical licensure
- Bachelor’s Degree
Responsibilities
- Generate medical referrals for specialists
- Evaluate services to achieve and maintain cost effective, quality health care
- Evaluate authorization requests for specialty care referrals
- Verify County eligibility
- Generate authorization referrals for Specialty Care
- Generate 15 Referrals daily or meets center capacity demand
- Generate letters as needed
- Fax referrals to medical providers as needed
- Process stat referrals as assigned
- Verify data requested from source documents is entered with a 95% accuracy rate
- Review statistical reports in Logi
- Assist the Business Operations Specialist in the development and implementation of guidelines to be used for consistent application of criteria
- Liaise with specialist providers requesting additional medical information as needed
- Back 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
- Scan and import medical records in accordance established standards
- Participate in quality improvement activities, including chart review, in-service programs, and staff meetings
- Fax Referrals and medical records to providers
- Submit employee activities report (EARS) in a timely manner
- Enter services and process billing claims
- Enter Services and tracking process for Directions Behavioral Health program, review clinical notes match claims and authorization
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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Number of Employees
1,001-5,000 employees
