Personnel Data Specialist

OPEN UNTIL FILLED

JOB SUMMARY:

The Personnel Data Specialist coordinates and manages the day-to-day operations of employees in the Agency’s human resource and payroll electronic system. Coordinates and completes all work to compute payroll by setting up all staff information into the electronic system which includes: all personal information, employment status, salary, position, payroll deductions, direct deposit information, supervisor information.

ESSENTIAL FUNCTIONS:

• Review all unapproved billable services identified in the electronic health record prior to billing schedule. Follow up with program staff to identify and resolve issues, and educate staff on requirements, in order to move claims forward into the revenue cycle. Prior to billing review claim diagnosis for compliance with program and payer requirements. Approve late documentation service adjustment requests per payer and Agency regulations. Review all documented substance use disorder services to ensure compliance with HIPAA and CFR requirements are met with the completion of the SA ROI. Perform monthly audits of service data relating to billing, payer and Agency compliance requirements. On a monthly basis, review 15% of all newly completed Financial Intake services for accuracy and adherence to Agency reimbursement procedure guidelines. Follow up with program staff if corrections are necessary. Review 5% of claims, comparing amount paid to the payer fee schedule.
• Develop, maintain, and provide reports and prepare custom reports, data searches, and/or data analysis in response to specific requests from other Agency staff and/or payers customers. Create and run standardized pre-and-post billing reports to ensure compliance with health plan agreements. Make necessary corrections on claims and/or follow up with reimbursement staff and/or providers as needed. Assist with identifying trends in billing workflow and coding issues to ensure clean claim submission.
• Complete all aspects of credentialing/recredentialing providers, to include but not limited to verification of application/documents, mailing of requests for consideration, initial applications, approval, denial, termination letters, and accurately maintaining provider information. Process credentialing/recredentialing applications accurately and promptly in accordance with health plan compliance requirements and industry standards (e.g., CAQH, PECOS, and NPI Enumerator). Manage staff credentials in Credible pertaining to billing aspects. Verify staff credentials via appropriate websites to ensure credentials are current for requirements of staff job and services provided. Track lapse of licenses, certifications and registrations for staff.
• Coordinate the SOAR (Social Security Outreach, Access and Recovery) program and other benefit eligibility for the Agency. Provide technical assistance and ensure data is entered in OAT. Coordinate with the local lead SOAR representative, attending meetings and addressing any DSS/SSI issues. Provide supervision to Eligibility Assistance Specialist. Serve as the Agency lead for the SOAR program.

• Prepare credentialing files and monthly matrices for presentation to the Reimbursement Manager; confirm the completeness of information and all documentation prior to presentation. Coordinate credentialing and recredentialing processes, maintaining task grids and tickler systems to assure follow up and completion. Maintain communication with programs to ensure credentialing review processes are completed in a timely manner. Review all credentialing changes in electronic health record to monitor for additional credentialing needs.
• Update databases and communicate provider changes to contracted health plans via standardized report(s). Responsible for accurate input and modifications, which includes performing audits to ensure accuracy. Responsible for processing the rosters (i.e., additions, changes, and terminations). Maintain ongoing communication with health plan representatives as well as frequently reviewing web-based materials to stay abreast of upcoming changes and new compliance requirements. Perform follow-up and complete requests, as necessary. Relay changes and compliance issues to supervisor.
• Understand and apply federal and state regulatory requirements, payer policy, and internal policy when performing reviews and tasks. Develop and present compliance education to reimbursement and program staff as needed.
• Coordinate, facilitate, and/or attend internal meetings representing reimbursement for credentialing and payer compliance issues (e.g., to provide guidance for new programs and special projects, disseminate information, provide insight to Agency regarding payer regulations, industry trends, and audit findings).

OTHER DUTIES:

• Perform such other job-related tasks as assigned by supervisor.
• Update job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; and participating in payer-provided webinars and trainings.

QUALIFICATIONS:

• Able to prioritize many tasks and exhibit excellent, mature judgment
• Possess self-motivation and be able to work independently with minimal supervision
• Strong organization and administrative skills
• Proficient in Microsoft Office Outlook, Word, Excel, and experience working with personal computers and working with an Electronic Health Record software
• Excellent communication skills, both written and verbal
• Knowledge of research data methodologies, analysis, and follow up
• Skills in staff development and training
• Knowledge of mental health, substance abuse, and developmental disabilities reimbursement processes
• Knowledge of medical records, regulations, practices, and procedures regarding medical records