Financial Representative 2 (777011)

Description of Work/Duties:

Consultant will work with the Department of Human Services, Office of Medical Assistance Programs (Department). Consultant will:

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

• Possess a high school diploma or GED. Should have knowledge of Medical Assistance and the billing process. Customer service and call center experience is preferred.

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

• Analyze billing inquiries to Medical Assistance to determine if the claim processed correctly and paid the correct amount. If the claim denied, they will determine the cause of the denial and explain to the provider the reason for the denial based off their knowledge of PA regulations and MA billing guidelines.

• Evaluate the providers Remittance Advice to explain to them their payments and assist them with their check details. This includes explaining any take back from Medical Assistance.

• Provide a proactive approach when answering calls from Providers and Recipients on the inquiry lines. This would include assisting the providers with how to bill their claims correctly. It would also include assisting recipients with understanding their benefit packages and locating providers.

• Evaluate billed information to determine if the proper procedure code and modifier were billed correctly. Also, determine if a procedure requires a prior authorization.

• Analyze claims to see if they meet 180-day exception criteria.

• Evaluate recipient’s assigned eligibility to see what services they are eligible for under Medical Assistance.

• Assist recipients with reimbursement requests by educating providers on their contractual responsibilities under the MA program.

• Review previously billed services for potential duplicate billing. Provide dental history research to avoid duplicate billing or denied claims from occurring.

• Determine the need to refer issues to external agencies or to the Bureau of Program Integrity for review.

• Answer questions from the provider and recipient community on various topics on the inquiry lines.

• Consultant will assist the recipients and providers with their billing issues.

• Consultant, when requested, will work at one or more of the Department's work sites. Consultant’s primary workstation will be at the Commonwealth Towers. 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.

• Consultant 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