OPS Medical Disability Case Records Specialist - 64801365

OPS Medical Disability Case Records Specialist - 64801365

The incumbent is responsible for the routine technical electronic records management activities relating to Social Security and Medically Needy disability claims. This includes receipt from the Social Security field offices and Department of Children and Families (Medically Needy cases), reviewing claims that are initialized through the automated claims process, initial review, pre-development, and assignment of disability claims. This requires the ability to comprehend written and electronic documents including a basic knowledge of medical terminology and comprehension of regulatory policies; ability to make independent case processing decisions' knowledge of the multiple case processing systems (i.e., Social Security Administration (SSA) system (Legacy system), PCOMM and eView); and the skill and ability to review and organize electronic documents.

The following outlines specific duties assigned. Initiates, develops, and maintains the electronic record management activities involved with the Case Coding, Consultative Examination (CE), and/or Medical Evidence of Record (MER) processes. All required information must be reviewed in the appropriate systems for completeness and accuracy and documented on the Electronic Worksheet (EWS) when appropriate. Conducts the initial file review upon receipt of claim. Reviews disability claim to determine completeness of file. Reviews medical disability and associated medical documents to determine if additional documentation needed, i.e., Medical Evidence Records (MER) all accounted for to support disability claim, initiates requests for MER (Case receipts, CE requests, claimant/MER source information) received from SSA offices/components/medical vendors or other Disability Determination Services (DDS) offices.

Reviews claim type(s) and paper folder indicators in eView and the previous case type and paper folder indicators in the Legacy system when necessary prior to receipting. Inputs appropriate system flags for "special" claim type in Legacy system and notates such in the Case Inquiry comment line. Obtains queries from the National DDS system database to verify on-line information as needed using the Legacy system prior to receipting. Copies medical evidence from the electronic folder to create a paper file when necessary. Inputs data, following special request procedures for designated MER vendor sources as required, to initiate the case receipt, case development, MER authorization and case closure processes, which will produce system-generated letters for MER vendor, claimant and other auxiliaries. Collates and prepares letters for mailing. Responds and processes edits which may be generated from the system. Inputs data, following special request procedures for designated CE vendor sources as required, to initiate the CE vendor selection, CE scheduling/rescheduling/cancellation/travel/CE authorization processes which will produce system generated letters for CE vendor, claimant and other auxiliaries. Collates and prepares letters for mailing. Notifies PRO of CE vendor address changes. Prepares claimant travel reimbursement packages and submits completed and signed invoice to DDD/Finance and Accounting office for payment. Validates and manually index faxed MERs received from medical vendor/claimant and other sources. Monitors CE authorizations in the fiscal queues, reviews note from DDD/Finance and Accounting office and/or adjudicator and updates information, as appropriate. Faxes CE authorization to vendor for signature if missing (notate action performed on comment line). Faxes signed CE authorization to the Legacy system for payment processing. Assists adjudicators with outstanding CE/MER authorizations and updates exam/authorization status as needed. Monitors and processes clerical follow-up requests and updates in the Legacy system. Completes closure process on completed claims, including proper coding/electronic input into legacy system sending file to appropriate designation and ensures paper files appropriately routed. Monitors system for errors generated by the automated closure process and conducts follow up. Reviews and processes incoming correspondences relating to the disability claim files, answers telephone, queries the Legacy system, and routes calls to the appropriate staff. Processes PPCS referrals and monitors the PPCS referral queues to ensure timely case processing. Notifies appropriate staff of any delays. Performs duties as a receptionist greets visitors, maintains sign in/sign out log, receives packages and routes to appropriate destination. Distributes printer and copier paper throughout facility. Performs mail center duties to ensure incoming cases and correspondences are distributed to appropriate destination and outgoing cases and correspondences are ready for pickup. Maintains inventory of mail room supplies. Performs other duties as required.

These duties will require access to Social Security Administration computer systems, DOH email system, Intranet and Internet applications, and may require access to the State of Florida Financial Systems.

Knowledge of and ability to operate general office automation equipment, i.e., personal computer, fax, copier, printer, scanner, etc. Knowledge of the SSA computer system and ability to generate MER and CE, process electronic invoices, schedule CEs. Scan documents and load/input into electronic data bases. Ability to analyze and gather information through review of files and identify missing/needed documentation. Ability to read and apply applicable regulatory policies, procedures, and guidelines. Ability to communicate effectively in writing and verbally. Basic knowledge of medical terminology.

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