Position Description

The individual in this position reviews service documentation, provides technical assistance and expertise related to private insurance, ADM, CFBHN, and Medicaid. This individual works closely with individuals who directly complete service data and financial data entry into the electronic health record system.

Position Expectation

In keeping with the mission and core values of Tri-County Human Services, all persons served, stakeholders, and fellow employees will be treated with dignity, respect, and shown sensitivity to their cultural diversity. Referenced by policy numbers 100.000, 100.000A, and 100.004.

Primary Duties and Responsibilities

• Reviews randomly selected electronic health records for the purpose of determining effective utilization and quality management of services provided.
• Enters audit results in electronic health record system for tracking and analysis.
• Coordinates with staff who directly input documentation to coordinate billing for CFBHN, TANF, PPWDC, FIS, Medicaid and private insurance to assure compliance with agency policy.
• Reviews clinical records to identify billable services that do not meet insurance documentation requirements. Advises Program Supervisor (or designee) of billing opportunities and missed opportunities and provides consultation to unit staff/supervisor regarding documentation necessary to bill said services.
• Provides documentation to facility supervisor and designated administrative staff of each audit’s findings and will perform follow-up on noted corrections done by staff to ensure compliance.
• Maintains an up-to-date knowledge base regarding Medicaid, PPWDC, TANF, FIS, and CFBHN/private insurance documentation and billing requirements through attendance at workshops and/or consultation with designated administrative staff in billing department.
• Provides on-going education to staff regarding documentation standards and guidelines to ensure that staff can comply with said standards.
• Trains assigned support staff at the facility on the proper billing and audit procedures to ensure compliance with internal and external requirements.
• Recommends to supervisory staff need follow up to the audited staff member any action, including disciplinary action, in consult with the Compliance Director.
• Assists compliance department with review, development, and update of Policy and Procedures.
• This position qualifies for short and long-term telecommuting per policy 100.027 – Telecommuting Guidelines.
• Provides other duties assigned

Minimum Training and Experience

Bachelor’s degree in behavioral health or another related field required. A master’s degree and a license as a LCSW or LMHC is preferred. Possesses computer operation skills, knowledge of Medicaid/private insurance, clinical documentation and billing procedures, strong organizational skills, and at least two (2) years full-time experience in a setting where the knowledge and skills were utilized. Demonstrates capability to monitor the quality documentation and service utilization trends.