Data Clerk

DEPARTMENT

Quality Assurance and Utilization Management

SCHEDULED HOURS

Between the hours of 8:00 AM-4:30 PM (varies as needed by department)

JOB DESCRIPTION

A.

PURPOSE AND SCOPE

a. To provide assistance to the Quality Assurance/Utilization Management Department in regard to authorization and billing errors. Acts as a liaison between the UM department and other staff regarding these errors

B. DUTIES AND RESPONSIBILITIES

a. Reads updates to DBHDD Provider Manual and other manuals provided by other oversight bodies and reports those changes to supervisor within 5 business days of the updates being posted. b. If an issue with compliance is noticed, will contact the appropriate staff to attempt to resolve the problem within 3 business days. c. Orders supplies such as paper, pens, etc. at the request of the Director or when supplies begin to run low (i.e., no less than 5 packs of paper). d. Answers emails and calls from staff about use of EMR within 1 business day e. Answers and returns phone calls and emails within 1 business day f. Uploads

CONNECTS

response files to the EMR daily g. Identifies and corrects/reports authorization errors within 2 business days. h. Batches

CONNECTS

files and posts to FTP site each day when Director is out. i. Runs failed claims report weekly to identify issues with no authorization for services and notifies appropriate staff within 3 business days. j. Sends CMO request same day as service is provided in order to authorize services. k. When problems arise with

CONNECTS

requests, will communicate with appropriate staff within 2 business days in order to resolve.

C. ORGANIZATIONAL RELATIONSHIPS

a. Communicates with the billing department as needed by submitting billing corrections to address billing errors. When a no prior authorization report is received, will communicate with appropriate bodies (Billing Department, ASO, or other staff) to get the prior authorization within 5 business days. b. Assists the Director and other staff with any external audits or reviews by communication with Program Directors which individuals will be reviewed and assisting the Director as needed during the audit or review. c. Reports to the Quality Assurance and Utilization Management Director.

JOB REQUIREMENTS

A. General Requirements a. When an obstacle arises, will continue to work on the project until it is resolved. If the employee is having difficulty resolving the issue, will communicate with staff, supervisor, or outside agencies that may be able to help resolve the problem. b. If corrective feedback is needed, will complete tasks assigned within 14 business days. This period of time may be changed at the discretion of the Director. c. Works 20 hours per week up to 30 depending on the needs of the department. Works between the hours of 8:00 AM to 4:30 PM Monday through Friday. When sick, will report via telephone each to supervisor in accordance with HR 7.01. If sick more than three days for an illness that may qualify as a serious illness, will request FML. d. Will request leave at least one business day before the requested day of absence. This policy may be waived at the discretion of the Director. e. Will abide by Dress and Appearance Code as stated in HR 50.0 f. Completes all Health and Safety modules annually, calls in sick when he/she believes he/she may be infectious, and will receive annual PPD. g. Completes annual learning by due date. h. Abides by

SBHS HIPAA

Policies by not releasing PHI to parties without a ROI, unless the release falls under exceptions as stated in

RI 11.01.

Will report any known breaches to the Corporate Compliance Officer within 1 business day. i. Completes other duties as assigned by the Director within the timeframe given by the Director. I have reviewed the responsibilities and requirements of my position with my supervisor and understand the performance expectations. I understand that Serenity Behavioral Health does no

Pay:

From $17.00 per hour

Work Location:

In person