PURPOSE

Performs all duties associated with enrolling clients in county specific benefit plans in the Managed Care Operation (MCO) software. Provides support to the Data Systems Manager and MCO Support Specialist; Manages provider claims including files and manual adjustments and corrections necessary to ensure services are paid according to Board contracted services and specifications.

ESSENTIAL JOB FUNCTIONS

• Receives and reviews all enrollment applications from the board contracted provider agencies for the MCO software;
• Ensures data for accuracy and completeness requesting clarification and further information from enrolling agencies prior to approval and entering enrollment into the MCO software;
• Seeks assistance from and provides consultation to Boards regarding enrollments, especially sliding fee scale and residency concerns;
• Manages member transfer notices between member Boards including reprocessing affected claims if applicable;
• Processes enrollment waiver requests and all associated member adjustments;
• Provides support to the Data Systems Manager and MCO Support Specialist;
• Assists and provides backup to the MCO Support Specialist regarding the support desk for MCO software system for boards and providers;
• Performs member changes for and re-adjudicates retroactive Medicaid claims;
• Works claims reports such as potential duplicate clients, Medicaid eligibility, "Orphan" Medicaid, and client demographics;
• Performs requested claims corrections;
• Ensures all work is HIPAA compliant;
• Provides customer service to all boards and providers;
• Assists in promoting cultural & linguistic competence within the Stark County community;
• Must work congenially and cooperatively with co-workers and public;
• Assumes added responsibilities and performs special projects as needed or directed.

REQUIRED QUALIFICATIONS

Education, Training and/or Experience

High School diploma or equivalent with two plus years' experience in data processing and/or information technology;

Knowledge, Skills, Abilities and Personal Characteristics

Understanding of the public Ohio Behavioral Health system (Boards /State Department/provider agencies and billing practices [Managed Care/MITS]) preferred. Quick, accurate data entry skills; Self-starter; Detail oriented; Excellent customer service attitude with good follow-through; Ability to handle multiple priorities; Knowledge of Microsoft Office products.

Certification, Licenses, Registrations

n/a

PHYSICAL DEMANDS

Nature of work requires ability to operate standard business office equipment. Requires ability to communicate and exchange information, collect, compile and prepare work documents, set-up and maintain work files. Travel by automobile will be required occasionally

WORKING CONDITIONS

Work performed in a general office environment. May require availability for additional hours during peak periods. Requires periodic participation and attendance at organization sponsored events and meetings.

This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of Stark County Mental Health & Addiction Recovery. Since no job description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, the changing nature of the job shall also be considered part of the jobholder's responsibility.

CONDITIONS OF EMPLOYMENT

Note: The final applicant selected for this position, prior to appointment, will be required to submit to a drug test for illegal drug use. The test site shall be chosen and paid for by the Board. An applicant with a positive test result will not be offered employment. Applicant will also be subject to any other requirements of Ohio law.

Salary Range: StarkMHAR Grade 2 $36,400-$50,960. *Suggested Starting Range $36,400 - $41,496

*An appropriate combination of education, training, course work and experience may qualify an applicant to demonstrate required knowledge, skills, and abilities that could qualify for a higher starting salary.

Hours: Monday - Friday 8AM to 5PM with one-hour unpaid lunch. Alternative scheduling may be available.

Application Deadline: Until Filled