DESCRIPTION
ESSENTIAL FUNCTIONS/DUTIES:
Strong knowledge of Medicaid Rule 132 Administrative Code and the Community Mental Health Service Definition and Guidelines.
Ability to understand, interpret and provide compliance feedback on the documentation cycle of assessment, treatment planning and service provision.
Ability to train staff on clinical documentation required to complete assessments, treatment plans, service notes and authorization requests.
Manage, monitor, and oversee all aspects of the Registration submittals and Authorization requests to enable Fee for Service (FFS) billing from DHS Medicaid and all Payers doing business with RSSI.
Conduct daily reviews of Medicaid documentation to assure compliance and appropriate content.
Provide direct feedback to Outreach Workers in regards to necessary corrections to Medicaid notes individual performance; escalating matters to proper supervisory staff as needed.
In conjunction with supervisor, remain current on any Medicaid regulation changes or proposals
Actively participate in pre-audit and audit activities, including Utilization Review process and any corrective action development needed to address deficiencies.
Provides one-on-one assistance for RSSI staff that have questions or need additional support.
Participate in end of year closing activities for Medicaid billing.
Responsible for understanding and complying with authorization and billing components of contracts.
Facilitate communication between funding sources and programs to ensure programs are meeting compliance requirements.
Evaluate that quality compliance, authorization and registration functions are operating effectively and efficiently by evaluating staff performance and skills on an ongoing basis, identifying and recommending courses of action for improvement.
Work with program staff and management to more effectively utilize Medicaid funding and identify problem areas.
Classify and monitor exceptions to Registration and Authorization rejections.
Manage and follow up on rejected billings relating to authorizations and registrations and collaborates with others to implement changes, as necessary, to reduce occurrence of trends. Responsible for correcting rejected billings due to authorization and registration issues in order for rebilling to occur.
Monitor processes and procedures to ensure authorization and registration procedures are efficient and effective. Recommends and develops improvements to policies, procedures and systems to meet agency objectives.
Responsible for ensuring registration, documentation, and authorization procedures are properly set-up in
Electronic Health Records System when new contracts/payers relationships are developed.
Design and generate reports as needed or requested.
Communicate technical material orally and in writing.
Works with Executive Director, Director of Programs and Director of Finance to ensure interdepartmental understanding of FFS billing requirements, authorizations and rejections.
Remains abreast of trends and regulations to ensure effectiveness and compliance for RSSI functions.
HOW TO APPLY
mbanghart@rssichicago.org