Office Services Clerk - Baltimore, United States - Goodwill Ind. of the Chesapeake.

Description

Job Description

MAIN PURPOSE OF THE JOB: The main purpose of this position is to provide general administrative support with data entry, sorting, batching, and logging request resulting from request submitted from providers for payment. Staff must have knowledge and experience performing diverse clerical duties which support agency operations that require the data entry, review, verification and interpretation of information in order to provide administrative support and assist with resolving problems in accordance with policies, regulations and laws applicable to agency programs. Individuals must be able to perform clerical functions which consist of data entry, sorting, processing, and filing of information and medical documents pertinent to agency programs, regulations and procedures. The Office Service Clerk is responsible for assisting with the fee for service documents as it pertains to professional and or institutional medical billing. Responsibilities include review, data entry, interpretation of materials/documents, printing, filing, sorting, mailing, emailing, compiling notices and files, pulling voice mail messages, responding to emails, maintaining and ordering supplies, and completing reports. This employee must have good interpersonal skills, the ability to complete correspondence and applicable forms to obtain information necessary for claim adjudication and or corrections to files. This employee may be required to review letters from physicians/hospitals to determine payable procedures and or recipient/provider eligibility. This position has many changing procedures in order to meet state and federal requirements while maintaining acceptable performance levels based upon standards for production and quality. This position may operate in a hybrid manner, meaning job duties will be performed both remotely and on-site (e.g., 10% remote, 90% onsite), based on the designated telework schedule/plan that best fits the unit and or otherwise directed by the Appointing Authority as well as other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

2.ESSENTIAL JOB FUNCTION AND OTHER ASSIGNED DUTIES - List duty and responsibility statements that identify the essential job functions and other assigned duties. Essential job functions are the fundamental job duties of a position that if not performed will alter the job. (Identify essential job functions by highlighting, underlining, etc.)

%OF TIME AND/

OR WEIGHT OF

IMPORTANCE JOB DUTY

20% CALL/MESSAGING: Retrieve, document, coordinate, organize, distribute and review incoming messages from provider call center/hotline. Accurate and timely entry of provider calls into tracker for fee for service inpatient, outpatient facility and professional service provider community.

20% MAIL, FAXES AND EMAILS: Retrieve, Sort, batch, log analyze and distribute mail, faxes and emails submitted from providers for assistance and evaluation of matters. By maintaining, tracking and recording data in excel files, google sheets and databases.

20% DOCUMENTATION TO PROVIDERS AND RECORD KEEPING: Create, copy, and send documentation to providers related to confirming receipt of information, confirmation of updates or payment and or return notice of incorrect or missing documents (claims/documents) for resolution.

20% APPEAL REQUEST/CLAIMS: Organize, file and Batch and maintain claims (B's, E's, H's & M's), provider files (inquiry cases and or claims).

20% TECHNOLOGY: knowledge and efficient use of computers, Microsoft programs, software, Medicaid Management Information System (MMIS-II). Knowledge of various technology, software, program regulations and policies are needed to evaluate documents received from provider/fiscal representative/MDH staff regarding provider nonpayment and billing issues identified for payment resolution.

3. LEVEL, FREQUENCY AND PURPOSE OF WORK CONTACTS: List the contacts

that this position has with individuals within the division, agency and department as well as other State agencies, other government agencies, private companies, clients, customers, vendors and the general public. These contacts may be in person, in writing or by telephone. Indicate how often the contact occurs. State the purpose of each contact, for example, to provide information, to explain procedures or decisions, to persuade or negotiate.

1. DIVISION CHIEF/ DEPUTY DIRECTOR - to discuss changes in Medicaid Policy, personnel concerns or issues, implementation of operational procedures and interpretation of existing Medicaid policy. Any issues concerning the handling of difficult and unusual case situations, clarity of departmental policies, guidance in the resolution of personnel issues.. (FREQUENTLY)
2. UNIT SUPERVISOR - to discuss issues with data entry, Medicaid Policies, personnel concerns or issues operational procedures and interpretation of existing Medicaid policy. Any issues concerning claims, providers, direction in the handling of difficult and unusual case situations, clarity of departmental policies, guidance in the resolution of personnel issues. (DAILY)
3. Other MDH Administrations – to confer, refer and or discuss policy issues regarding payment or non-payment of various services with staff specialists related to recipient eligibility, provider enrollment, professional and institutional providers (LTC facilities, physician, ambulatory, DME/DMS , home health, personal care providers, waivers, labs, hospitals, etc.) (FREQUENTLY)
4. Medicaid Providers – professional and institutional providers (LTC facilities, physician, ambulatory, DME/DMS, home health, personal care providers, waivers, labs, hospitals, etc.) (FREQUENTLY)

4. DECISIONS AND RECOMMENDATIONS: List the decisions and recommendations that this position makes which are necessary to carry out essential job functions. State to whom recommendations are made.

Determines if proper Program policies and procedures have been met to process request.

Determine if proper guidelines have been met to ensure program eligibility of the recipient or provider.

5. EQUIPMENT USED - List equipment, machinery and tools used to complete this job, e.g., personal computer, calculator, typewriter, hand tools, measuring devices and lab equipment.

Personal computer, laptop, cellular phone, telephone, calculator, photocopier and fax machine

6. NATURE OF SUPERVISION RECEIVED - Check the type of supervision that is given to this position. See Instructions Part II, Item 6 for definition of terms.

X Close Supervision

Moderate Supervision

____ General Supervision

Managerial Supervision

7. WORKING CONDITIONS: (Check all that apply)

Work involves exposure to uncomfortable or unpleasant surroundings. (Explain)

Work involves exposure to hazardous conditions which may result in injury.

(Explain)

Work involves special physical demands such as lifting 50 pounds or more,

climbing ladders, etc. (Explain)

Work requires use of protective equipment such as goggles, gloves, mask, etc.

(Explain)

PART III. RESPONSIBILITY FOR THE WORK OF OTHERS

This section should be completed if this position is responsible for the work of others, this includes full and part-time permanent employees, contractual or emergency employees, volunteers, reimbursable or loaned employees. If additional space is required, attach a separate sheet.

NATURE AND LEVEL OF RESPONSIBILITY FOR WORK OF OTHERS:

A supervisor assigns and reviews the work of others, trains employees, recommends the selection, promotion and termination of employees, approves leave and signs time cards, signs annual performance evaluations, determines and resolves procedural problems within the unit, servers as spokesperson for subordinates, explains policies and directives from management and issues formal disciplinary reminders, warnings and reprimands.

A lead worker assigns and reviews the work of others, instructs and motivates workers, is available for immediate assistance or review and performs the work of the classification.

a). Does this position supervise employees? Yes No X

b). Does this position lead employees? Yes No X

c). Check the ways that this position supervises or leads these employees. (check all that apply).

Assign and review work

Approve leave, sign time cards

Sign annual performance ratings

Interview & select new employees

Train employees

Discipline employees (counsel, recommend suspension & termination)

d). Do any of the employees supervised have supervisory responsibility? If so, list them and the names and classifications of those they supervise or attach an approved organization chart.

N/A

PART IV. PERFORMANCE STANDARDS

PERFORMANCE STANDARDS - For each essential job function described in Part II, list the standard(s) necessary for satisfactory performance. If additional space is required, attach a separate sheet.

1. To retrieve, document, coordinate, organize, distribute and review incoming messages from provider call center/hotline by accurately and timely retrieving and entering provider calls into tracker for fee for service inpatient, outpatient facility and professional service provider community by meeting a standard of satisfactory by processing 15-30 calls per hour per day while being professional and courteous at all times. Ensure all requests/messages are documented accurately and timely as established.

Satisfactory = 15-30 OUTSTANDING = 31-75 or more

1. Retrieve, Sort, batch, log analyze and distribute mail, faxes and emails submitted from providers for assistance and evaluation of matters. By maintaining, tracking and recording data in excel files, google sheets and databases. This is based upon the review of information to ensure that the program polices have been met based on current procedures and regulations by meeting the standard of satisfactory of processing per day.

Satisfactory = OUTSTANDING = 81 or more

1. Create, copy, and send documentation to providers related to confirming receipt of information, confirmation of updates or payment and or return notice of incorrect or missing documents (claims/documents) for resolution by meeting the standard of satisfactory per day

Satisfactory = 80-100 OUTSTANDING = 101 or more

1. Organize, file and Batch and maintain claims (B's, E's, H's & M's), provider files (inquiry cases and or claims by meeting the standard of satisfactory per day

Satisfactory = 80-100 OUTSTANDING = 101 or more

1. Knowledge and efficient use of computers, Microsoft programs, software, Medicaid Management Information System (MMIS-II). Knowledge of various technology, software, program regulations and policies are needed to evaluate documents received from provider/fiscal representative/MDH staff regarding provider nonpayment and billing issues identified for payment resolution by meeting the standard of satisfactory with an error and knowledge base of 80% or more.

Satisfactory = 80 % or more OUTSTANDING = 81% or higher