State of Hawaii
Exempt, Non-Civil Service Appointment. The primary purpose of this position is to provide monitoring and technical support for contracted provider agencies and the CAMHD Family Guidance Center (FGCs) to review and assess the quality of services provided. The purpose of the review is to assure high quality care, effective and efficient delivery of services through the examination of practices in order to achieve outcomes for youth served.
The primary function of the Health Systems Management Office (HSMO) is to provide understanding and knowledge of healthcare billing practices, reforms and Medicaid to the CAMHD staff; to ensure operations and business practices are developed, coordinated, structured, and maintained in alignment with federal, HIPAA, and state health records, billing, and credentialing standards and compliance requirements; to develop, coordinate, and monitor quality assurance; and to ensure information technology system operations, planning, and strategy for maximization of ongoing and alternative sources of funding.
The subject position reviews, audits, and ensures timely processing of CAMHD contracted providers’ billing and claims, and to ensure they are in compliance with federal and state laws including federal healthcare regulations, MedQUEST insurance standards, and CAMHD contract requirements and performance management standards.
EDUCATION: Possession of a bachelor’s degree in healthcare, business, finance, accounting, or a related field from an accredited college or University required. Master’s Degree in healthcare, business, finance, accounting, or related field preferred.
EXPERIENCE: Experience in auditing, billing and claims operations in healthcare; experience in utilization management in retrospective and concurrent reviews; experience operating in a regulated environment involving compliance of federal, state, and local laws and regulations, and/or corporate policies and procedures.
2 ½ years of progressively responsible work experience in conducting and analyzing performance reviews including case-based reviews. Experience must also have included extensive report writing and other methods of presenting findings and data. 1-year professional experience involved in children and adolescent’s mental health care.
LICENSE: Valid Hawaii Driver’s License Preferred. Certifications and/or accreditations in claims reviews, medical and billing record management, medical and billing record auditing, healthcare fraud investigations, project management, and claims coding also preferred.
Visit the Dept. of Health website to view requirements and application packet: http://health.hawaii.gov/employment/job- opportunities/
Mail application packet to:
Recruitment is continuous until needs are met.
For additional information, you may contact
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Notice #: 0001248344-01
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