• Job Description

  Req#: 4952209
  GENERAL STATEMENT OF DUTIES: To assist in the supervision of a phase of a statewide program designed to furnish medical care benefits to eligible recipients of the Rhode Island State Medical Assistance Program, to review the work of clerical assistants engaged in examining and approving for payment, bills for a variety of medical services; and to do related work as required.
  SUPERVISION RECEIVED: Works under the general supervision of a superior from whom assignments and instructions are received with considerable latitude for the exercise of initiative and independent judgement; work is subject to review occasionally in process but usually upon completion through conferences and for results attained as well as conformance to established policies and objectives.
  SUPERVISION EXERCISED: Assists in planning, supervising and reviewing the work of a clerical staff.
  • To review the work of clerical assistants engaged in examining and approving for payment, in accordance with prescribed regulations, bills from the providers of: in-patient hospital services, out-patient hospital services, (clinic, accident room, diagnostic and therapeutic x-rays, pharmacy), physicians' services, drugs, dental services, optometric services, other laboratory and x-ray services, surgical appliances, visiting nurses services, podiatry services, ambulance service, skilled nursing home care, and intermediate care.
  • To investigate and determine validity of claims from outside the state, and of any others which present difficult determination of eligibility.
  • To consult with Social Workers and Physicians with regard to requests for special medical items or services which are not available through regular provider channels and to advise them of other available community resources.
  • To review medical and social information relating to applications for admission to nursing or intermediate care facilities.
  • To review and apply informational and directive communications bearing on federal and/or state legislation with reference to the medical care program, and other related programs.
  • To assist in the preparation of rules, regulations, procedures, and fee and cost standards governing the procurement and payment of medical services and supplies; and to inform local welfare directors, certifying officers and other welfare officials and staff members thereof.
  • As required, to compile statistics and prepare special reports on various phases of the program.
  • To do related work as required.
  KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of the provisions of the Rhode Island Medical Assistance Program as it relates to in-patient hospital services, nursing and intermediate care services, visiting nurse services, and drugs for consumption by in-patients or other persons; the ability to interpret and apply such knowledge; the ability to supervise and review the work of clerical assistants engaged in examining and approving for payment bills for a variety of medical services; the ability to assist in the preparation of rules, regulations, procedures, and fee and cost standards governing the procurement and payment of medical services; the ability to maintain good relations with associates and the public; and related capacities and abilities.
  EDUCATION AND EXPERIENCE:
  Education: Such as may have been gained through: graduation from a college of recognized standing; and
  Experience: Such as may have been gained through: employment in a responsible position assisting in the supervision of the processing of claims, or requests for benefits or services in such areas as medical care administration, hospital administration, public administration, social welfare, or in a health or accident insurance program.
  Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.
  
  Preferred Skills and abilities:
  
  
  • 1 to 3 years experience working with RI Bridges and MMIS systems.
  • Knowledge and experience in completing Medicaid applications and submission.
  • Knowledge and experience in completing Social Security applications and submission.
  • Experience in interviewing and interaction with various patient populations serviced by BHDDH.
  • Knowledge and experience working with insurance benefits, obtaining patient benefits, completing precertification’s, obtaining authorizations for patient hospital stays and third party liability as well as patient collections.
  • Ability to learn various billing and insurance applications\databases used daily.
  • Knowledge of basic computer skills including but not limited to excel and word.
  • Excellent written and verbal skills preferred.
  • Highly organized and detailed oriented.
    

• About the company

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