RemoteDescription:Claims Clinical Documentation ReviewerThis role is responsible for reviewing clinical and supportive documentation submitted by providers for Medicaid services (medical, behavioral health, client service, etc.) to ensure compliance with client regulations.This position maintains confidentiality regarding member PHI and provider casesReports to the client Assistant Director and Assistant Deputy Director.Job Duties:Conducts rereviews of behavioral health clinical records under the oversight of the client AD and ADD.Completes and submits standardized audit tools to the client AD and ADDAttends meetings with OGC, client staff, and providers as needed.Knowledge of:Service Authorization concepts, principles, and strategiesAdvanced knowledge of the behavioral health service delivery system and the needs of children and the needs of individuals designated as SMIPrinciples of behavioral health management and assessmentIndividual service planning process and substance abuse treatmentHCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelinesMedical technology, computer data retrieval and input, including EHR, HIE, etc.Medicaid and Medicare client Regulations, State Statute, Rules, and Policies applicable to client programsThe client program design and implementation, prior authorization functions and responsibilities, provider network, and funding source.Familiarity with American Indian Tribes, programs and policy.Skills in:Problem solving identification, evaluation, and imitation of appropriate action and case management assessmentExcellent verbal/written communication skills, with FFS Providers Organizational skills to coordinate, monitor and report on multiple cases simultaneouslyAnalytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendationsStrong interpersonal skills in working with people of diverse cultures and socioeconomic backgroundsDocumentation, research, and reporting of data and trendsStrong computer skills including Microsoft and Google SuitAbility to:Strong ability to collaborate with others for mutually beneficial outcomesInterpret clinical information and assess implications for treatmentRead, interpret, and apply complex rules and regulationsIndependent decision making yet knowing when to elevate the decisionDrive long distances when requiredAbility to work TelecommuteExperience:One year of clinical and programmatic experience working with the behavioral health service delivery systems preferred.Preferred:Advanced experience in clinical and/or claims supportive documentation review and analysis.Requirements:Behavior Health License, associate or independent in AZNotes:8:00 AM - 12:00 PMNo over time offered.Remote Position, Equipment is provided by facility.This position maintains confidentiality regarding member PHI and provider cases, has the potential to work from a Virtual Office (VO), and works 5 - 10 hours per week.VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status
Description:Claims Clinical Documentation ReviewerThis role is responsible for reviewing clinical and supportive documentation submitted by providers for Medicaid services (medical, behavioral health, client service, etc.) to ensure compliance with client regulations.This position maintains confidentiality regarding member PHI and provider casesReports to the client Assistant Director and Assistant Deputy Director.Job Duties:Conducts rereviews of behavioral health clinical records under the oversight of the client AD and ADD.Completes and submits standardized audit tools to the client AD and ADDAttends meetings with OGC, client staff, and providers as needed.Knowledge of:Service Authorization concepts, principles, and strategiesAdvanced knowledge of the behavioral health service delivery system and the needs of children and the needs of individuals designated as SMIPrinciples of behavioral health management and assessmentIndividual service planning process and substance abuse treatmentHCPCS codes Levels I & II and, knowledge of International Classification of Diseases, DSM IV/V coding and medical billing guidelinesMedical technology, computer data retrieval and input, including EHR, HIE, etc.Medicaid and Medicare client Regulations, State Statute, Rules, and Policies applicable to client programsThe client program design and implementation, prior authorization functions and responsibilities, provider network, and funding source.Familiarity with American Indian Tribes, programs and policy.Skills in:Problem solving identification, evaluation, and imitation of appropriate action and case management assessmentExcellent verbal/written communication skills, with FFS Providers Organizational skills to coordinate, monitor and report on multiple cases simultaneouslyAnalytical skills to identify and correlate specific patterns, initiate investigations, submit findings and recommendationsStrong interpersonal skills in working with people of diverse cultures and socioeconomic backgroundsDocumentation, research, and reporting of data and trendsStrong computer skills including Microsoft and Google SuitAbility to:Strong ability to collaborate with others for mutually beneficial outcomesInterpret clinical information and assess implications for treatmentRead, interpret, and apply complex rules and regulationsIndependent decision making yet knowing when to elevate the decisionDrive long distances when requiredAbility to work TelecommuteExperience:One year of clinical and programmatic experience working with the behavioral health service delivery systems preferred.Preferred:Advanced experience in clinical and/or claims supportive documentation review and analysis.Requirements:Behavior Health License, associate or independent in AZNotes:
8:00 AM - 12:00 PMNo over time offered.Remote Position, Equipment is provided by facility.This position maintains confidentiality regarding member PHI and provider cases, has the potential to work from a Virtual Office (VO), and works 5 - 10 hours per week.
(Please ensure email matches your resume email)
(document types allowed: doc/docx/rtf/pdf/txt) (max 2MB)
By submitting this form, you are consenting to the VIVA team contacting you via Phone/Email