Assists in the planning, organizing, leading and directing of the claims, authorization and UASNY data acceptance and error correction process for both Medicare & Medicaid.
Position is heavily involved in research, investigation, monitoring and corrections for federal, state and local regulations governing Archcare Senior Life.
Position will assist in the development of documentation that supports education of the Care Members in relation to Claims, Authorizations and UASNY assessment requirements.
Assists in the generating of reports for submission to the quality and compliance department.
Will be responsible for the development of timelines to assist with project completion and administrative reporting.
Provides oversight and direction in establishing and maintaining data systems for developing, reviewing, approving claims, authorizations and UASNY Quality Indicators and Preventative Health Services
Responsible for monitoring the claims, authorization and UASNY data acceptance and error correction processes for both Medicare and Medicaid.
Performs research, investigation and corrections of claims, authorizations and UASNY Quality Indicators.
Keeps program in compliance with federal and state regulations
Assist in the development of documentation for quality and compliance reporting.
Attends and participates in planning and staff meetings to ensure communication on key topics to all levels.
Provides oversight and direction in establishing and maintaining data systems for developing, reviewing, approving, authorizing claims, UASNY Quality Indicators, Preventative Health Services, DSRIP and Meaningful Use requirements.
Education & Experience
· Associates Degree Health Care Administration
· ICD-10 Coding Certification
· Medical Billing Certification
License, Registration, and / or Certification Requirement: yes
Language Ability: Bi-Lingual preferred
Associates Degree in Health care Administration required
Bachelors Healthcare Administration Preferred
ICD-10 Coding Certification and Medical Billing Certification required
Minimum of 5 years progressive experience in a human services and/or healthcare environment.