SR. Administrator at Independent Living Systems in Miami, FL

Description

POSITION SUMMARY

This position is responsible for the development, testing and maintenance of benefit plans including client-specific authorization requirements, timely filing parameters and claim editing for Independent Living System/Royal Health Care clients. This individual provides training and support to the other Benefit Programming Analysts in the department and additional operational areas as deemed appropriate.

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Analyzes changes of product design to determine the effect on the end product design and function and determines and prepares documentation necessary for change. Coordinates with customers and manufacturers to determine a process for change reporting. Reviews released engineering change data and changes documenting activities to ensure adherence to configuration management procedures and policies.

REQUIREMENTS FOR ALL POSITIONS

All employees shall meet Compliance/Privacy Regulations and attend at a minimum one (1) hour of

Compliance/Privacy educational training annually, as required by Independent Living Systems.

All employees shall meet Risk Management Regulations and attend at the minimum one (1) hour of

Risk Management education and training within the first thirty (30) days of employment and as required by law or Independent Living Systems; and, for that non-physician in clinical direct care delivery services, annually thereafter.

POSITION RESPONSIBILITIES AND ACCOUNTABILITY

• Develop and test benefit plans programmed in the eClaims claim transaction system through use of intermediate/advanced level Boolean logic via User Value Assignment

Modules (UVAMs).

• Identify and strategize cost saving measures through analysis of claim data across clients

• Assure compliance with regulatory requirements, including but not limited to,

NYSDOH model contract

• Define, analyze and deliver routine and ad hoc reports as necessary

• Prepare written specifications to the data center to modify the eClaims system and test enhancements before introducing changes into production environment.

• Document and educate staff of system enhancements

• Provide support, guidance, and training to other Benefit Programming

nalysts

• Maintain written documentation supporting the benefit development and testing process, in addition to, assisting co-workers in the development of departmental policies and procedures

• Perform various tasks associated with new client implementation and system migration from other processing systems into eClaims, including but not limited to, benefit building

• Analyze claim suspensions to identify and program modifications essential to optimizing claim auto-adjudication

• Support staff in answering questions pertaining to claim adjudication including EDI and

Optical Character Recognition (OCR) functionality

• Troubleshoot high-level system-related issues to identify root cause, brainstorm and communicate the resolution necessary to effectuate change

• Maintain and train co-workers on the development and maintenance of eClaims

UVAMs including associated departmental policies and procedures

• Effectively communicate up-to-date information to all staff, including management

• Assist with high volume workloads as necessary

• Participate in corporate projects as required

• Flexible day/evening hours

• Direct contact with current and potential clients as necessary

• Occasional travel required

TELECOMMUTING OPPORTUNITY

• If offered the opportunity to work remotely, the employee’s workdays are to be defined and followed. Any changes to work schedule must be approved by management in advance.

• The work hours will be pre-determined by the manager and employee including start time, stop time and scheduled breaks. If any changes need to be made to the schedule it must be approved by the manager in advance

• Employees with young children must plan to provide childcare during work hours.

• If there is a connectivity issue, the employee must go into the office or take PTO.

• Productivity during telecommuting is expected to be the same or increased than working in the office. If management identifies a decrease in productivity the telecommunicating opportunity will be revoked

The telecommuter may be required to come into the office for trainings, special projects, department meetings and client visits, etc. This will be deemed by the manager as appropriate.

POSITION QUALIFICATIONS

• Bachelor's degree or 0-3 years of experience in the field

• Experience including Medical Claim Examiner/Coder, Business Analyst or Trainer

• Knowledge of UB04 / CMS1500 claims, ICD-9, ICD-10/ Revenue / CPT / HCPCS diagnosis and procedure coding, claim adjudication processes, EDI and OCR claim submission, Medicare and Medicaid reimbursement methodologies including APR

DRG / Exempt Units / APG / RBRVS / APC.

• Knowledge of eClaims and Boolean logic preferred

• Proven ability to effectively and efficiently analyze data and summarize in an organized and professional manner

• Ability to read and interpret contracts and other related documents required

• Function in a fast-paced environment that requires prioritizing workloads and multi- tasking to complete projects on time

• Team player that can work well independently and make decisions without excessive

supervisory oversight

• Excellent verbal, written and presentation skills required

• Proficient in Microsoft Office (Word, Excel, PowerPoint, and Access) required

OTHER COMPETENCIES:

❖ Ethical Conduct.

❖ Strategic-Critical Thinking.

❖ Leadership.

❖ Decision Making.

❖ Financial Management.

❖ Communications Proficiency.

❖ Presentation Skills.

TRAVEL

This position requires up to 15% travel. Frequently travel is inside/outside the local area and overnight.