Department Assistant

Summary:
To support the CFTO program to ensure that client authorizations for services are obtained and tracked and to work with both the billing and clinical services department to resolve problems that prevent us from billing for a service or collecting reimbursement from an insurance company.

 

Responsibilities:
MAIN DUTIES AND RESPONSIBILITIES:

Maintain authorization data on CFTO client who are receiving EOS CAITS CFIT and IHBT services tracking approved authorization dates and units through both the electronic record system and Excel spreadsheets.



Input and retrieve data from CMHC process various utilization reports and maintain accuracy of client information.



Communicate with clinical staff and program managers to correct information that has resulted in billing errors.



Communicate with designated insurers to obtain authorizations as delineated in the CFTO Service Protocols for CAITS CFIT EOS and IHBT.



Confirm medical eligibility and insurance authorizations as needed to initiate services and/or address billing errors.



Make adjustments to service coding as needed in the electronic record to resolve billing errors.



Maintain appropriate documentation to back-up authorizations given by insurers both in the electronic record and paper copies when needed.



Provide reports to billing and clinical staff to assist in performance monitoring and improvement activities.



Attend meetings with billing and/or clinical staff to discuss assess and plan protocol that will maximize revenue for the program.



Other duties and responsibilities as assigned or needed.

 

Other information:
QUALIFICATION REQUIREMENTS:

Minimum high school diploma or general education degree (GED) with two years related experience in managing medical/mental health insurance protocol including authorizations and billing.



NECESSARY SPECIAL REQUIREMENTS:

Knowledge in Excel and ability to work in an electronic record.



JOB KNOWLEDGE SKILL AND ABILITY:

Knowledge of office procedures.

Ability to read and comprehend simple instructions short correspondence and memos.

Ability to write simple correspondence.

Ability to handle multiple priorities and work with minimum supervision.

Ability to carry out duties independently and in a timely manner in a diversified setting.

Good communication skills and pleasant manner on telephone and in person.

Ability to operate computer typewriter copy machine and postage meter.

Oral and written communication skills including speech grammar spelling and legibility are at sufficient level to ensure effective and appropriate communication.

Familiarity with agency's policies and procedures relating to client rights client records and confidentiality.

Ability to successfully complete all required training and certifications.



ETHICS:

Uses and accesses information in client's health information record or about a client only as necessary to actual duties and then only in accordance with access levels assigned to this position by Gateway Healthcare Inc. from time-to-time and in accordance with Gateway Healthcare Inc. policies rules and procedures as adopted by Gateway Healthcare Inc. from time-to-time.

Comply with agency ethics and codes of conduct in all contacts with clients co-workers and the community.

Observe all agency policies and procedures.



INTERPERSONAL FACTORS:

Must be able to appreciate the sensitive/private nature and legal status of information about individual clients obtained maintained or used by Gateway Healthcare Inc. and to not access use disclose or request such information about a client unless necessary to the performance of his/her job.



PHYSICAL/ENVIRONMENTAL FACTORS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the main duties and responsibilities of this job. Other duties with different demands may also be assigned by the employee's supervisor. Gateway complies with the Americans with Disabilities Act and analogous state statutes. Therefore to the extent required by law Gateway will make reasonable accommodations to allow qualified individuals with disabilities to perform the essential functions duties and responsibilities of their positions. Employees and applicants should discuss requests for reasonable accommodations with Human Resources at any time.



While performing the duties of this job the employee is regularly required to use hands to finger handle or feel objects office equipment or controls and talk or hear. The employee frequently is required to walk sit reach with hands and arms and climb. The employee is occasionally required to stand; stoop kneel crouch or crawl; and taste or smell. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision distance vision peripheral vision depth perception and the abilities to adjust focus.



The noise level in the work environment is usually moderate.

 

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

 

Location: Gateway Healthcare Inc. USA:RI:Pawtucket

 

Work Type: Full Time

 

Shift: 1

 

Union: Non-Union