This position is responsible for assisting with efficient processing of Office of Addiction Services Intensive Case Management Claims, Behavioral Health Special Initiative (BHSI) claims processing, assists with updates and other duties as related to the database and information systems utilized by BHSI staff. Assists with expedited enrollment processes and supports other fiscal functions of BHSI.
Duties and Responsibilities:
Protect the privacy of client information and uphold the security of the client records as directed by BHSI Policies and Procedures.
Determine Medicaid (MA) eligibility through PROMISe and other State systems.
Process outbound 270 files (Request for Eligibility) and inbound 271 files (Reply to 270) for both OAS ICM and BHSI
Update MA history information in billing system.
Assist OAS Manager of Information Systems and BHSI Assistant Director with research projects and by providing specialized data entry
Research data entry issues and other system problems in all versions of the Office of Addiction Services Information System (OASIS)
Maintains code tables, provider information and other data elements that provide infrastructure to OASIS
OAS ICM Functions
Upload, track, request and enter authorizations for OAS Intensive Case Management Unit (OAS ICM).
Process clinical updates including reformatting and organizing as needed for the OAS ICM unit for submission to Community Behavioral Health.
Generate and review claims to insure eligibility and submit claim batches to ICM payers as scheduled.
Track and resolve Third Party Liability issues.
Submit adjustments and appeal requests
Process claims submission response files .
OAS BHSI Functions
Assist providers with issues involving the Strengthening Treatment and Recovery (STAR) data system
Maintain PMHCC contracts in the SCA Data System (SDS)
Maintain provider user logons to BHSI web site
Assist providers with issues relating to BHSI web site
Process and Track MA Expedited Enrollment submissions
Assists with monitoring client data entry and merging when needed
Participate in NIATx project and other DBHIDS projects as assigned
Provide data entry assistance to other BHSI units as need
Research provider claims issues and assist with resolution
Coordinate and complete bulk mailings
Assist with telephone coverage.
Support and distribute faxes.
Process inbound and outbound claims files on schedule
Process authorization requests and update to CBH on schedule
Ensure accuracy of data being submitted to CBH and others
Perform accurate data entry in a timely manner
Resolve provider issues in a professional manner
Able to work independently, and complete assignments without close supervision. Good organization skills and detailed oriented. Able to meet deadlines. Able to effectively multi-task. Good written, verbal, communication decision and presentation skills. Strong interpersonal and diplomacy skills, positive attitude and teamwork driven. High level of interpersonal skills to manage sensitive and confidential information. Understand and follow written and oral instructions. Computer literate; knowledge with intermediate skill levels in Microsoft Suite. Type 30 wpm.
Education and Experience:
High School Diploma, with at least four (4) years related office support experience in a human service setting or Associates Degree with two (2) years related office support experience in human service.
Ability to physically perform the duties and to work in the environmental conditions required such as maneuvering in office space-reaching file cabinets, fax, and copier machines when necessary; must be able to sit for up to two (2) hours looking at a computer monitor and using a keyboard and mouse to perform data entry functions; able to travel locally via public transportation and on foot from 801 Market Street to 1101 Market Street, 123 S. Broad Street, and various other destinations when necessary. Ability to travel to meetings and site visits within the City of Philadelphia and surrounding counties, as needed; valid driver’s license.
PMHCC - 10 months ago