OPERATIONS & MGMT CONSULTANT MGR - SES - 64051634

State of Florida • Panama City Beach, FL

1d • $50,000 - $65,000 • Onsite

About The Position

This position spends the majority of the time engaged in supervisory responsibilities. This includes communicating with, motivating, training, and evaluating employees in addition to planning and directing employees’ 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.

The position performs a variety of complex support and supervisory functions which require substantial technical, financial, administrative and operational knowledge of accounting practices for the Florida Department of Health’s medical and dental programs. The duties of this full-time supervisory position will be dedicated to maximizing local accounts receivables through third party payers (Medicaid, Medicare, private insurance companies, organizations, etc.) for personal healthcare and dental services provided by qualified staff of the Florida Department of Health in Bay County (DOH Bay) as well as contracted County Health Departments within the DOH Bay Billing Hub. The incumbent in this position is a member of the DOH Bay Billing Hub and is responsible for supervising the provision of medical and dental billing to contracted County Health Departments that are members of the DOH Bay Billing Hub. The incumbent in this position is responsible for the integrity and confidentiality of data sets under his/her control.

Interacts with contracted members of the DOH Bay Billing Hub to develop processes and procedures used to support those counties in ensuring their medical and dental billing is performed in an accurate and timely manner. Works closely with staff to make sure contracted counties’ billing needs are met.

Supervises and plans the workload, deadlines, work objectives, and time utilization of the DOH Bay Billing Hub staff. Reviews, verifies, and approves employees’ Employee Activity Report records. Provides training of staff within the scope of a supervisor. Provides technical advice to staff on the establishment and maintenance of accounting procedures.

Processes all third-party reimbursement claims for personal healthcare and dental services provided by DOH Bay and contracted members of the DOH Bay Billing Hub.
Ensures all third-party payments are posted to the applicable clients’/organizations’ account within the Health Management System (HMS) and denied claims are to be researched and resubmitted within seven working days of the date of denial is received per DOH Accounts Receivable Policy, DOH 56-66-08. Solves billing problems by combining, evaluating and reasoning with information and data to reserve issues. Decision making and resolutions discussed and approved by immediate supervisor prior to implementation.

Coordinates and implements the credentialing process for DOH Bay as a group and for all healthcare and dental providers for third party payers (Medicaid, Medicare, and insurance companies who require or offer better reimbursement rates for providers who are credentialed) by gathering, maintaining and recording professional information and qualifications about the providers. Is the practice administrator for the DOH Bay information contained within the Council for Affordable Quality Healthcare (CAQH) website.

Develops and maintains current standards for submitting, receiving and following up of claims denied from third-party reimbursement sources. The standards will provide guidelines for medical 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 Bay and contracted counties within the DOH Bay Billing Hub for reimbursement by the above referenced standard beginning monthly with corrective action plan for non-compliant claims.

Provides technical assistance to all staff providing medical and dental services involving third-party reimbursement from agencies and/or insurance companies. Provides training for all staff responsible for entering third-party insurance information into HMS and serves as the HMS Billing Administrator. Is the Account Administrator, uses, trains and provides support for staff required to use the following websites in order to perform functions of their positions:

1. Availity

4. MCNA

7. HMS

10. PAYSPAN

2. Change Health

5. CMS Med3000

8. TRAIN

11. Cigna

3. Dentaquest

6. FLMMIS

9. LIBERTY

12. Sunshine

Prepares statistical reports on a monthly basis: reports 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 or client write-off accounts, 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. Analyzes statewide revenue reports to assist in determining appropriate action plans to increase revenue collected by DOH Bay.

Established and maintains relationships with various community organization representatives wishing to set up billing accounts with DOH Bay. Maintains up to date listings of all organizational billing accounts and provides updates to cashier(s). Submits monthly billing of all organizational accounts and follows up with organization representatives on any delinquent accounts.

Processes all client accounts for write-off and sent to collections routine in HMS on a monthly basis, following procedures outlined in the DOH Accounts Receivable Policy, DOH 56-66-08, completed for all contracted counties with the DOH Bay Billing Hub. Interacts and provides assistance to DOH Bay clients who have questions regarding accounts that have been written off or sent to a collection agent and takes appropriate action to resolve accounts.

Audits eligible services monthly to verify that all services eligible to be billed to Medicaid were billed correctly. Corrects and rebills any billing errors discovered and bills client service to Medicaid when clients are assigned to coverage retroactively. Ensures client monthly statements are printed and mailed to clients who have any outstanding balance owed to DOH Bay. Answers incoming calls from clients who have questions about their bill and/or want to make payment plan/arrangements.

Incumbent will serve as the DOH Bay Billing Hub Manager to include oversight of 11 staff who perform the billing functions for 11 County Health Departments: Bay, Jackson, Calhoun, Liberty, Dixie, Gilchrist, Levy, Santa Rose, Duval, Gulf, and Franklin.

Performs all other duties as assigned or as necessary.

Requirements

• Knowledge and experience with medical billing procedures.
• Knowledge and experience 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.
• At least three years of extensive medical or dental billing with the Florida Department of Health
• At least three years of experience using the DOH Health Management System (HMS).

Responsibilities

• Communicating with, motivating, training, and evaluating employees in addition to planning and directing employees’ work.
• 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, complete performance reviews, maintain vacation and work schedules, ensuring proper coverage and complete timesheets.
• Maximizing local accounts receivables through third party payers (Medicaid, Medicare, private insurance companies, organizations, etc.) for personal healthcare and dental services provided by qualified staff of the Florida Department of Health in Bay County (DOH Bay) as well as contracted County Health Departments within the DOH Bay Billing Hub.
• Supervising the provision of medical and dental billing to contracted County Health Departments that are members of the DOH Bay Billing Hub.
• Interacts with contracted members of the DOH Bay Billing Hub to develop processes and procedures used to support those counties in ensuring their medical and dental billing is performed in an accurate and timely manner.
• Supervises and plans the workload, deadlines, work objectives, and time utilization of the DOH Bay Billing Hub staff.
• Reviews, verifies, and approves employees’ Employee Activity Report records.
• Provides training of staff within the scope of a supervisor.
• Provides technical advice to staff on the establishment and maintenance of accounting procedures.
• Processes all third-party reimbursement claims for personal healthcare and dental services provided by DOH Bay and contracted members of the DOH Bay Billing Hub.
• Ensures all third-party payments are posted to the applicable clients’/organizations’ account within the Health Management System (HMS) and denied claims are to be researched and resubmitted within seven working days of the date of denial is received per DOH Accounts Receivable Policy, DOH 56-66-08.
• Coordinates and implements the credentialing process for DOH Bay as a group and for all healthcare and dental providers for third party payers (Medicaid, Medicare, and insurance companies who require or offer better reimbursement rates for providers who are credentialed) by gathering, maintaining and recording professional information and qualifications about the providers.
• Develops and maintains current standards for submitting, receiving and following up of claims denied from third-party reimbursement sources.
• Provides technical assistance to all staff providing medical and dental services involving third-party reimbursement from agencies and/or insurance companies.
• Prepares statistical reports on a monthly basis
• Established and maintains relationships with various community organization representatives wishing to set up billing accounts with DOH Bay.
• Processes all client accounts for write-off and sent to collections routine in HMS on a monthly basis, following procedures outlined in the DOH Accounts Receivable Policy, DOH 56-66-08, completed for all contracted counties with the DOH Bay Billing Hub.
• Audits eligible services monthly to verify that all services eligible to be billed to Medicaid were billed correctly.
• Incumbent will serve as the DOH Bay Billing Hub Manager to include oversight of 11 staff who perform the billing functions for 11 County Health Departments: Bay, Jackson, Calhoun, Liberty, Dixie, Gilchrist, Levy, Santa Rose, Duval, Gulf, and Franklin.
• Performs all other duties as assigned or as necessary.

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 (For more information, please click www.myfrs.com);
• Flexible Spending Accounts;
• Tuition waivers;

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed