Financial Representative 2 (764168)

Description of Work/Duties:

Based on the Governor’s recent Executive Order prioritizing work experience and skills over educational attainment - Have knowledge of Medical Assistance, health care insurance, health care provider participation/enrollment, provider or pharmacy service authorization and the medical claims and billing process. Experience in customer service and/or call center experience is a plus. Possess a high school diploma or GED. A bachelor’s degree in accounting, business, math or a human services field will be considered in lieu of experience.

Consultant will work with the Department of Human Services, Office of Medical Assistance Programs (Department). This is a professional level position responsible for various operational aspects of the Fee-for-Service Medical Assistance program. This involves a wide range of tasks related to health care claims and billing, resolution of health care provider financial accounts, health care provider enrollment, and prior authorization for health care and pharmacy services. Consultant will perform a wide range of duties depending on the Division within the Bureau the position is assigned:

• Be available as a consultant on average 37.5 hours per week;

• Possess basic computer skills, including familiarity with Microsoft Office programs.

• For Division of Clinical Review, the Financial Representative 2 consultant duties include:

· Coordinate with other agencies and entities arranging health care screenings and case management services for eligible juveniles in a carceral setting with follow up, as appropriate.

· Develop and implement a process to track health care screenings and case management services for eligible juveniles in a carceral setting.

· Reports out on required data collected within the Medicaid Management Information System (MMIS) for eligible juveniles in a carceral setting to internal and external stakeholders.

· Act as a liaison, fielding inquiries and information for carceral settings, case management entities, and other agencies for eligible juveniles in a carceral setting and provides guidance.

· Schedule calls and teleconferences for Medical Directors, compile information to be included in the teleconference packets, and forward to the appropriate Medical Director for their review and use.

· Act as a backup for scheduling calls for designated nurse reviewers to external providers.

· Access Medical Assistance provider-submitted prior authorization requests and forward to designated nurse reviewers for clinical determinations.

· Field inquiries and coordinate with designated clinical staff for their resolution.

· Other administrative duties, as assigned.

Consultant, when requested, will work at one or more of the Department's work sites. Consultant’s primary work station will be at the Commonwealth Towers located at 303 Walnut Street in Harrisburg, PA. Consultant will be provided with a desk, computer, and all items necessary for him/her to complete assignments. If Consultant is unable to appear at the scheduled work site at the pre-determined times, notification must be made to the Work Site Supervisor either prior to date or on date of absence.

• Consultants will be evaluated on:

· Quality of work product;

· Appropriateness of work habits;

· Growth of knowledge base and skill set;

· Effectiveness of communications;

· Initiative and problem-solving skills;

· Contributions to a productive and hospitable work environment.

About Us:

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.

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