OPERATIONS & MGMT CONSULTANT II - SES

Operations & Management Consultant II - Ses - 64084119

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. 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.

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

Supervision, attention to details, time management, initiative, and problem solving

Where you will work: Panama City, Florida