Administrative Specialist II / BPH C&A / HIS Insurance

Job Responsibilities

Are you passionate about making a real difference in people's lives? Join our team at the Office of Mental Health where we are dedicated to providing compassionate and accessible care to our community. We are seeking a [Internal/Functional Job Title] who is motivated to help individuals and families navigate life's challenges and achieve long-term wellness. If you want to use your skills to build a healthier, more resilient community, we encourage you to apply.

This position is located at the SC Department of Behavioral Health and Developmental Disabilities (DBHDD) - Office of Mental Health– Inpatient Services, 220 Faison Drive, Columbia, SC 29203.

As the Administrative Specialist II, working under general supervision, applies the policies and procedures of the Medicare/Medicaid and third-party programs for inpatient alcohol/drug and psychiatric services. Determines patient's eligibility under Medicare/Medicaid/Tricare and prepares forms. Assists the Utilization Review Nurse by providing all insurance information timely and making the required pre-certification calls with insurance companies within the required time period. Serves as contact person for C-213. Responsibilities for the Administrative Specialist:

• Uses different computer systems to determine and verify Medicare/Medicaid/Tricare and third-party eligibility on all patients. Interview patients upon admission regarding insurance coverage. Enters the financial eligibility into Avatar. Obtain and maintain authorizations for release of medical information from patient and/or policy holders. Notify UR Nurse of all insurance and makes pre-certification contacts within the required time frames. Trouble shoot and investigate insurances for Reimbursement/Billing. Keep abreast of changing federal regulations governing the Medicare/Medicaid/Tricare Programs.
• Contact the mental health centers (MHC) when necessary, to obtain a Medicaid CON for urgent and voluntary admissions as well as a 257 and the Emergency Concurrence forms within one working date, following admission. Follow-up with the ME Cs at least weekly, to obtain such information. Regarding emergency admissions, ensures that the Medicaid CONs are completed by the BPH C&A Treatment Team. Works closely with the OMH Reimbursement Staff; providing them with the above-mentioned forms and other necessary insurance information.
• Prepare correspondence for insurance companies to include sending copies of required records to Reimbursement, for retrospective reviews and appeals.
• Complete the morning report on all insurances identified for that day and emails the report to the UR nurse and other appropriate staff as required, by 1:00 p.m.
• Maintain compliance with Corporate Compliance, Harassment-Free Workplace policies, Time and Attendance policies and facilities requirements for cultural awareness training.

Minimum and Additional Requirements

• A high school diploma or GED.
Additional Requirements:
• Must be able to walk to patient areas and travel between campuses.

Preferred Qualifications

• Associates degree in secretarial science or other related field or a high school diploma with two (2) years of experience, of which one (1) year is in Medicare/Medicaid/Tricare.
• Bilingual abilities in English and Spanish (or another language) are a plus.

Additional Comments

Post hire, employee must:

• Be able to administer and follow guidelines of Medicare/Medicaid/Tricare programs.
• Maintain a high level of confidentiality when releasing information.
• Apply judgement regarding the operation of the area.
• Be aware an employee in this position is considered essential.

The Department of Behavioral Health and Developmental Disabilities is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

Supplemental questions are considered part of your official application. Any misrepresentation will result in your disqualification from employment. Please complete the state application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position.

The Department of Behavioral Health and Developmental Disabilities offers an exceptional benefits package for full time (FTE) employees:

• Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children.
• 15 days annual (vacation) leave per year
• 15 days sick leave per year
• 13 paid holidays
• Paid Parental Leave
• S.C. Deferred Compensation Program available (S.C. Deferred Compensation)
• Retirement benefit choices *
• State Retirement Plan (SCRS)
• State Optional Retirement Program (State ORP)

*Enrollment in one of the listed plans is required for all FTE employees; please refer to the contribution section of hyperlinked retirement sites for the current contribution rate of gross pay.