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Data Validation Specialist

4 months ago

Tucson, United States Catholic Community Services of Southern Arizona Inc Full time
Job DescriptionJob Description

Catholic Community Services of Southern Arizona, Inc. (CCS) is thriving For 90 years, CCS has focused its mission to strengthen families, support communities, provide compassionate services, and deliver excellence. Providing Help. Creating Hope. Serving All.

We credit our continued success to our valuable employees If you want to make a difference, help people, and serve your community, we want YOU to join our team For more information visit our website at: www.ccs-soaz.org.

OVERVIEW

Under direction of the Director, Revenue Cycle, responsible for reviewing and auditing medical records to ensure documentation contained justifies data billed on encounters, and correction and resubmission of denied claims or invoices are submitted within a timely fashion. Also responsible for periodic, ad hoc, and month end reporting. Position may from time to time be stressful and require a high demand of performance. May perform other duties as assigned.

ESSENTIAL FUNCTIONS

  • Ensures error-free claim submissions in compliance with Regional Behavioral Health Authority (RBHA) contracts; state legislation; any accreditation standards; and AHCCCS, Arizona Department of Health Services (ADHS), and Division of Behavioral Health Services (DBHS) regulations regarding data validation
  • Maintains and prepares all medical records for audit and/or review by various funders
  • Compiles and releases medical records in accordance with HIPAA, agency, and funding source requirements; researches manual files and electronic health record (EHR) files to gather or verify data needed for eligibility determinations and/or benefits application processing
  • Responsible for retention and destruction of medical records; arranges for purging or relocating files to a storage facility according to guidelines set by agency and funding source
  • Ensures confidentiality of all medical record information in accordance with all HIPAA regulations
  • Utilizing internal reports, determines omissions and correctness errors, while also and measuring timeliness of encounter submissions
  • Reads and audits member medical records to ensure documentation is free of errors and ready for error-free claim submission
  • Compiles error grid in collaboration with the Director, Revenue Cycle and presents to staff and supervisors on a weekly basis
  • Scrubs documentation of basic administrative errors (incorrect date, time, etc.). to ensure error-free claim submission
  • Conducts data validation reviews and audits of randomly-selected AHCCCS-enrolled member medical records
  • Compares medical records with encounter data submissions in order to justify accurate coding of services provided
  • Tracks, trends, and analyzes data from audits and works in collaboration with the Director, Revenue Cycle to provide actionable solutions to staff
  • Reads and comprehends state and federal rules and regulations related to billing
  • Prepares periodic, ad hoc, and month end reports
  • Tracks, monitors, and implements improvement actions for specialized projects; evaluates the successes and opportunities for improvement in such actions
  • Provides support and/or assistance to other departments to ensure accuracy of data
  • Works with the direct supervisor and leadership team to effectively resolve issues, identify training needs, and improve data validation efforts throughout the agency
  • Provides training and technical assistance to agency staff
  • May drive personal or agency vehicle on company business
  • May perform other duties as assigned

MINIMUM REQUIREMENTS

Suitable work experience may be considered as transferable skills in order to meet minimum requirements of the position and will be considered by the Executive Director of Human Resources.

  • High School Diploma or GED
  • 2 years of experience working in medical billing, data validation, and claims submission and resubmission (preferably behavioral health)
  • Obtain State of Arizona Level One Fingerprint Clearance Card
  • Valid driver license, proof of insurance, and 39-month motor vehicle report
  • Proven skills utilizing Microsoft Office Suite
  • Proven strong communication skills - oral and written are clear, concise, and in an organized fashion using appropriate style, grammar, and tone

REGULATORY

  • Must be at least 18 years of age
  • Valid driver license, proof of insurance, and 39-month motor vehicle report
  • Ability to obtain and maintain Arizona Level One Fingerprint Clearance Card and FBI National Criminal Records History Report (employer paid)
  • Pass pre-employment drug screen (incudes marijuana, regardless of recreational use laws) (employer paid)

DESIRED QUALIFICATIONS

  • Associate Degree
  • Billing and/or coding certification and/or credential
  • Additional years of directly-related experience
  • Behavioral health work experience
  • Experience working with Arizona Medicaid providers in relation to billing
  • Bilingual in English and Spanish, verbal and written

The above statement reflects the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered a detailed description of all work requirements that may be inherent in the job.

We are an Affirmative Action Equal Opportunity Employer for all individuals. All qualified applicants are encouraged to apply.