OPERATIONS & MGMT CONSULTANT II - SES - 64084119

State of Florida • Panama City Beach, FL

1d • $43,000 - $46,000 • Onsite

About The Position

This position spends the majority of the time engaged in supervisory responsibilities, including communicating with, motivating, training, and evaluating employees, as well as planning and directing their work. The incumbent has the authority to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline subordinate employees or effectively recommend such action. The incumbent will also be required to develop performance expectations, meet with staff regularly to discuss performance, complete performance reviews, maintain vacation and work schedules, ensuring proper coverage, and complete timesheets.

This position performs a variety of complex operations and management support functions which require substantial technical, financial, administrative and operational knowledge of accounting practices. It also requires a thorough understanding of medical and insurance claim procedures. The duties of this position will be dedicated to maximizing local accounts receivables through third party payers (Medicaid, Medicare, private insurance companies, organizations, etc.) for personal medical and dental services provided by qualified staff of the Florida Department of Health (DOH) and assists management in the utilization of the Health Management System (HMS) currently in use by DOH. The incumbent in this position is responsible for the integrity and confidentiality of data sets under his/her control.

Oversees and participates in the processing of the daily operations of a medical billing department, ensuring accuracy and compliance with healthcare regulations, internal DOH policies and procedures and confidentiality guidelines are met.

Processes third party reimbursement claims for personal healthcare and dental services provided by DOH Duval County and other counties serviced by the DOH Bay County Billing Hub, which includes verifying clients’ Medicaid, Medicaid Managed Care, Medicare, or other Third Party Liability coverage, verifying clients’ medical service are correctly coded (both CPT and ICD 10), correcting and rebilling any errors discovered, and verifying that correct billing practices are followed.

Ensures all third-party payments are accurately posted to the applicable client’s account within HMS and denied claims are researched and resubmitted within 30 days of the date of denial received per DOH Accounts Receivable policy (DOH-56-66-17). Works independently to solve billing problems by evaluating and researching using available tools and information to determine resolution of the claim to include crossover claims, corrected claims, appealed claims, Agency of Health Care Administration (AHCA) complaints, etc. Must remain up to date with all local policies and procedures as they pertain to billing as this position will advise staff as needed on DOH billing procedures.

Develops and maintains current standards for submitting, receiving, and following up of denied claims from all third-party reimbursement sources. The standards will provide guidelines for healthcare and dental providers to ensure accuracy and validity of claims submitted for reimbursement. Responsible for evaluating and monitoring all third-party claims submitted by DOH Duval for reimbursement by the above referenced standards beginning monthly with corrective action plan for non-compliant claims.

Assist in the training and support of staff required to use various websites to perform functions of their positions which may include the following web portals: Availity, Change Health, Medicaid, Payspan, Dentaquest, liberty, Capital Health, etc.

Prepares statistical reports as requested by the DOH Bay Financial Administrator. Report will include number of third-party reimbursement claims by vendor, amount filed, amount received, number and amount of denied claims by vendor, reasons for denial, number of denied claims resubmitted for payment, number of client write-off accounts and amounts, number of accounts sent to state collection agency. Prepares trend reports as described above beginning July 1 of current fiscal year and concurrently thereafter.

Assists internal clients with HMS billing reports, as needed. Audits eligible services monthly to verify that all services eligible to be billed were billed correctly. Assist in the correction and rebilling of any errors discovered and bills client service to Medicaid when clients are assigned to coverage retroactively.

Supervises multiple billing staff employees to provide billing and related services to DOH Duval. Provides training and oversight on all billing functions provided by the staff assigned to DOH Duval.

Provides other related duties as required by this position.

Requirements

• Knowledge and experience with medical billing procedures
• Knowledge and experience with understanding medical terminology
• Ability to review and input data with 100% accuracy
• Ability to use and learn varied computer programs to include HMS, Availity, FLMMIS, and Microsoft Office
• Ability to work independently with a sense of urgency to meet deadlines
• Skills required: supervision, attention to details, time management, initiative, and problem solving.
• Valid driver’s license
• Ability to learn and communicate effectively, orally and in writing, in English.

Responsibilities

• Supervise employees, including communicating with, motivating, training, and evaluating them.
• Plan and direct employees' work.
• Have the authority to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline subordinate employees or effectively recommend such action.
• Develop performance expectations, meet with staff regularly to discuss performance, and complete performance reviews.
• Maintain vacation and work schedules, ensuring proper coverage, and complete timesheets.
• Perform complex operations and management support functions requiring technical, financial, administrative, and operational knowledge of accounting practices.
• Understand medical and insurance claim procedures.
• Maximize local accounts receivables through third party payers (Medicaid, Medicare, private insurance companies, organizations, etc.) for personal medical and dental services.
• Assist management in the utilization of the Health Management System (HMS).
• Ensure the integrity and confidentiality of data sets.
• Oversee and participate in the processing of daily operations of a medical billing department, ensuring accuracy and compliance with healthcare regulations, internal DOH policies and procedures, and confidentiality guidelines.
• Process third party reimbursement claims for personal healthcare and dental services, including verifying coverage, coding, correcting errors, and ensuring correct billing practices.
• Ensure all third-party payments are accurately posted to client accounts within HMS.
• Research and resubmit denied claims within 30 days of denial.
• Solve billing problems independently by evaluating and researching resolutions for claims, including crossover claims, corrected claims, appealed claims, and AHCA complaints.
• Advise staff on DOH billing procedures.
• Develop and maintain current standards for submitting, receiving, and following up on denied claims from all third-party reimbursement sources.
• Evaluate and monitor all third-party claims submitted for reimbursement.
• Assist in the training and support of staff required to use various websites for their positions (e.g., Availity, Change Health, Medicaid, Payspan, Dentaquest, liberty, Capital Health).
• Prepare statistical reports for the DOH Bay Financial Administrator, including data on claims filed, received, denied, resubmitted, client write-offs, and accounts sent to collections.
• Prepare trend reports.
• Assist internal clients with HMS billing reports.
• Audit eligible services monthly to verify correct billing.
• Assist in the correction and rebilling of errors and bill client services to Medicaid when clients are assigned to coverage retroactively.
• Supervise multiple billing staff employees to provide billing and related services.
• Provide training and oversight on all billing functions for assigned staff.
• Perform other related duties as required.

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
• Education Level: No Education Listed