Financial Representative 2 - 649831
Financial | Harrisburg, PA | Contract
TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.
Contract Position Filling Justification
Bureau: BUREAU OF FEE FOR SERVICE PROGRAMS
Division: DIVISION OF PROVIDER OPERATIONS
SECTION: ENROLLMENT AND CERTIFICATION SECTION
CONTRACTOR POSITION TITLE: Financial Representative
DATE TODAY: 3/29/2021
DATE OF VACANCY: 4/5/2021
INCUMBENT CONTRACTOR NAME: Andrea Nester
(If new position then note N/A.)
MAJOR POSITION DUTIES AND RESPONSIBILITIES:
- Maintains working knowledge of MA regulations at 55 PA Code 52 and 1101 Regulations governing HCBS waiver providers.
- Performs manual and electronic review of provider enrollment applications and forms, provider agreements and other required documentation.
- Responds to phone calls, emails, and other correspondence from providers, representatives, and other stakeholders. This requires extensive knowledge of regulations, policies and procedures, and the ability to provide instruction to providers on how to complete enrollment applications and forms accurately. Must have the ability to effectively communicate information to others.
- Reviews documents for adherence to Departmental policy, standards, and guidelines, including current Medical Assistance regulations and CMS waiver guidelines where applicable.
- Develops and maintains relationships with appropriate agencies, such as the Department of Health, Office of Developmental Programs, Area Agencies on Aging, or other stakeholders regarding ongoing certification or licensure requirements.
- Maintains the appropriate databases for data input, research, and analysis, updating, and reporting purposes.
- Input and maintain provider information in PROMISe™, HCSIS, SAMS, and Provider Access tables.
- Coordinates Community Health Choices (CHC) and Affordable Care Act (ACA) activities and monitors the impact of these initiatives on provider enrollments and internal policies and procedures. This includes communicating changes to other OLTL Bureaus, program offices, and stakeholders.
- Responsible for updating, scanning, and loading provider documents into the appropriate systems.
- Performs other related duties as required.
JUSTIFICATION FOR FILLING~ this position must be filled to insure the following:
This contracted position supports the day to day provider enrollment activities for over 1,500 HCBS waiver providers. This position is one of four staff that supports the Certification and Enrollment Section. This Section is the first point of contact for all OLTL providers requiring assistance with enrollment related activities.
A Financial Representative is needed to maintain the day to day operations. Day to day operations include managing calls, resolving provider issues, initial enrollments, ownership changes, name and address changes, changes and adding of services, revalidations, and voluntary and involuntary closures. With new initiatives such as Community Health Choices (CHC) and the Affordable Care Act (ACA), and the increased workload surrounding these initiatives, this Section will be unable to maintain current workload if this position is not filled. This may result in work being out of compliance with Federal and State mandates and regulations.
POTENTIAL RAMIFICATIONs IF NOT FILLED:
If this position is not filled it could result in numerous complaints from providers, legislators and the community resources due to unanswered inquiries and correspondence. This position will ultimately affect the quality of services provided to the HCBS consumers. Waiver providers and other agencies will be unable to get the appropriate information for questions and concerns related to provider enrollment. In addition, the transfer of knowledge may be lost within the various workgroups.
TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com