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Administration / Operations
Responsible for navigating clients, health care providers (Medical and AIDS Service Organizations (ASO)), and other stakeholders through the different insurance and care options in Ryan White Part B, HealthPLUSAlabama, and DentalPLUSAlabama to ensure a seamless continuum of care across multiple resources. Will also facilitate UWCA staff and providers in the CEU programs in relation to RWPB, HPAL, and DPAL.
- Maintain denial database for both Health Plus Alabama (HPAL) and Dental Plus Alabama (DPAL).
- Follow up with providers to determine resolution of denials and resubmission of pertinent claims.
- Documents all claims actions in appropriate software.
- Protects operations by keeping claims information confidential and in compliance with HIPPA laws
- Audit medical and pharmacy claims and co-pays to bills.
- Act as a liaison with UWCA e-services support team and ADPH to follow up with ASO on clients who have failed to certify or recertify for HPAL and DPAL in a timely fashion.
Continuing Education facilitation
- Assist the UWCA compliance manager as needed for various CEU events sponsored by UWCA.
- Act as a liaison in tandem with UWCA compliance manager to facilitate CEU events sponsored by ADPH.
- Other Job Duties as assigned.
- Maintains work operations by following policies and procedures; reporting compliance issues
- Assist with completion of annual ADPH audit as needed.
- Maintain working knowledge of funding source rules and regulations
Knowledge and Skills:
Candidate must have current Licensed Social Worker (LBSW or LCISW) licensure valid in the state of Alabama. Medical Case management a plus. Knowledge of processing of medical or pharmacy claims, good customer service, data-entry, word processing and phone skills are imperative.