HUMAN SERVICES PROGRAM ANALYST

HUMAN SERVICES PROGRAM ANALYST - 64030726

Location: St. Petersburg Health Department, 205 Dr MLK Jr St N, St. Petersburg FL 33701.

Primary Duties: Referral Generation

• Evaluates services to achieve and maintain cost effectiveness, quality health care. Authorized to limit services based on medical necessity and procedural guidelines. Uses professional guidelines for Specialty Care. Develop 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.

Data Review

• 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.

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.
• 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.

Required Knowledge, Skills, and Abilities

• 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.

Qualifications

Minimum

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

Preferred

• Medical Licensure
• Bachelor’s Degree

The Benefits of Working for the State of Florida

• 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

Legal & Equal Opportunity Statements

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace.

Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center View phone number on click.appcast.io). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

Veterans’ Preference. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement.