- Evaluates services to achieve and maintain cost effective, quality health care. Authorized to limit services based on medical necessity and procedural guidelines. Uses professional guidelines for Specialty Care. Develops procedures to evaluate medical necessity.
- Evaluates authorization requests for specialty care referrals in accordance to the established Specialty Care medical grid(Radiology, Behavioral and other specialties)
- Verifies County eligibility.
- Generates authorization referrals for Specialty Care in accordance with established procedural guidelines in HMS ACG.
- Generates 15 Referrals daily or meets center capacity demand.
- Generates letters as needed. Faxes referrals to medical providers as needed.
- Processes stat referrals as assigned.
- Verify data requested from source documents is entered with a 95% accuracy rate.
- Review statistical reports in Logi.
- Assist the Business Operations Specialist in the development and implementation of guidelines to be used for consistent application of criteria.
- Liaisons with specialist providers requesting additional medical information as needed.
- Backs up DOH pharmacy tech to provide pharmacy services to PCHP clients as assigned, to include overrides/prior authorizations or denials.
- Access pharmacy voicemails and phone calls from medical providers as needed.
- Use portal information center.
- Scans and imports medical records in accordance established standards.
- Participates in quality improvement activities, including chart review, in-service programs, and staff meetings.
- Faxes Referrals and medical records to providers.
- Submits employee activities report (EARS) in a timely manner.
- Enter services and process billing claims.
- Enters Services and tracking process for Directions Behavioral Health program, review clinical notes match claims and authorization.
- Knowledge of medical terminology.
- Knowledge of Pinellas County Health and Health Care for the Homeless Plans.
- Ability to plan, organize and coordinate work assignments.
- Ability to establish and maintain working relationships with others.
- Ability to type and/or in a keyboard control data input device and utilize other office equipment.
- Ability to follow instructions.
- Ability to review data for accuracy and completeness.
- Ability to meet and maintain minimum production requirements for speed and accuracy.
- Ability to communicate effectively both written and verbal.
- Skills in Information Technology.
- Annual and Sick Leave benefits;
- Nine paid holidays and one Personal Holiday each year;
- State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options;
- Retirement plan options, including employer contributions
- Flexible Spending Accounts;
- Tuition waivers;
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Human services Program Analyst - St Petersburg, United States - State of Florida
Description
Requisition No: 828233Agency:
Department of Health
Working Title:
HUMAN SERVICES PROGRAM ANALYST
Pay Plan:
Career Service
Position Number:
Salary:
$37, $40,000. Internal applicants will follow policy.
Posting Closing Date: 05/14/2024
Total Compensation Estimator Tool
Thank you for your interest in career opportunities with the Florida Department of Health in Pinellas County. If you are looking to establish a successful career in Public Health, you have come to the right place. Many of our innovative and successful health programs are recognized throughout Florida. We hope you decide to join our team Applicants will be contacted directly if selected for an interview.
The incumbent is part of a global public health organization and is expected to support the Florida Department of Health in Pinellas County in its mission to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts and its efforts and its vision To be the Healthiest State in the Nation.
Furthermore, the incumbent is expected to incorporate the agency values of Innovation, Collaboration, Accountability, Responsiveness andExcellence in all aspects of their work.
Your Specific Responsibilities:
This position is an Analyst within the Specialty Care Program, whose primary functions are to generate medical referrals for specialists in the Pinellas County Health and Health Care for the Homeless Plans.
Primary Duties :
Referral Generation
INDIRECT SERVICES AND OTHER DUTIES
Qualifications:
Minimum:
Experience in Health Care and / or a Clinical Setting
Advanced skills in Information Technology
Knowledge and Understanding of Medical Terminology and standard abbreviations
Preferred:
Medical licensure
Bachelor's Degree
Florida Department of Health Mission, Vision, and
Values:
Mission:
To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.
Vision:
To be the Healthiest State in the Nation.
Values:
I nnovation:
We search for creative solutions and manage resources wisely.
C ollaboration:
We use teamwork to achieve common goals & solve problems.
A ccountability:
We perform with integrity & respect.
R esponsiveness:
We achieve our mission by serving our customers & engaging our partners.
E xcellence:
We promote quality outcomes through learning & continuous performance improvement.
Where You Will Work:
St. Petersburg Center; 205 Dr. M. L. King Jr. St. N., St. Pete, 33701
The Benefits of Working for the State of Florida:
Working for the State of Florida is more than a paycheck.
The State's total compensation package for employees features a highly competitive set of employee benefits including:
Please be advised:
Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process.
This position requires a security background check and/or drug screening and participation in direct deposit
Note:
You will be required to provide your Social Security Number (SSN) in order to conduct this background check.
Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS.
For more information, please visit the SSS website:
If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida.
Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement.The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system.
E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility.
Incumbents may be required to perform emergency duty before, during, and/or beyond normal work hours or days.Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women.
The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and/or expertise.
Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of an honorable discharge.
These initiatives help ensure that the transition from military service into the workforce is as smooth as possible and reflects our appreciation for the dedication devoted to protecting our country.
The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.
Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.
The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section , F.S., Drug-Free Workplace Act.#J-18808-Ljbffr
