SCHEDULE: 40 hours, Monday-Friday, 8:30am-5:00pm
This position is responsible for the healthcare strategy and compliance across the organization, which includes all Medicaid billable programs including the Stabilization Day Treatment Program, under the direction of the Senior Director of Behavioral Health. The Director will monitor healthcare trends, and will identify additional revenue sources through new and current contracting models. The Director works closely with Pine Street Inn's finance department, oversees the work of the billing coordinator, and liaisons with the billing intermediary. The Director works to implement and oversee special healthcare initiatives and oversees the work of the Coordinator of Special Housing Initiatives as well as the Medical Billing Coordinator. This position is responsible for ensuring the compliance of department policies related to HIPAA, 42 CFR Part 2, Privacy Practices, Medicaid Fraud and Billing and in addition, monitoring and informing senior leadership of the changes to state regulations and insurance contracts. This position provides consultation to the Chief Operating Officer and Program Leadership team in the area of Healthcare Strategy and Compliance.
- Master's degree in Social Work, Counseling Psychology, or related field
- A minimum of two (2) years of supervisory experience working in a clinic setting
- An understanding of Managed Care Organizations, payor contracts and billing
- A working knowledge of Homeless Management Information Systems and/or ETO data system
- A minimum of two (2) years' experience as the system administrator/primary high-level administrator of an electronic health record, such as CareLogic
- Knowledge of low income and homeless individuals
- Knowledge of 42 CFR, Confidentiality and HIPAA regulations.
- Ability to use stairs
- Strong verbal and written communication skills with the ability to effectively manage external and internal relationships
- The ability to follow written and verbal instructions, function independently, and make independent decisions when circumstances warrant such action
- Strong judgment in prioritizing the performance of tasks, duties and responsibilities in accordance with written standards, policies and procedures.
- Strong interpersonal skills
- High level of computer literacy and knowledge of Electronic Health Records, Windows, Access and Excel spreadsheets.
- Ability to prioritize and work effectively and independently with in a busy work environment with a high volume of client related paperwork
- Ability to function well as a team coordinator and work effectively with a diverse team The ability to train direct reports and colleagues in areas of expertise
- Bilingual/Bicultural English/Spanish
- Prior supervisory or management experience.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
- Links Mission to day-to-day work, focuses on meeting organizational targets, recommends or develops plans for improvement.
- Technoloqy and Healthcare trends: Keeps abreast of emerging technology and healthcare trends and educates PSI staff and leadership, making change recommendations as needed. Analyzes and shares timely information on the impact of healthcare trends on PSI's behavioral health programs with the Senior Director of Behavioral Health. Participates on EOHHS/Mass Health Working Groups as assigned and selected. Conducts presentations as requested on PSI's relationship to healthcare initiatives. As requested, cultivates relationships with Healthcare entities to create future contracting opportunities. Works with the Senior Director of Behavioral Health and the Senior Director of Strategic Initiatives on business plans for future programming.
- Medicaid and Corporate Compliance: Serves as the designated Compliance Officer for PSI's Medicaid Billable Programs, and chairs the Corporate Compliance Committee. Ensures compliance with contract reporting requirements; Maintains and provides written annual updates of the Department's Corporate Compliance Plan and will assume the managerial and administrative tasks involved in establishing, monitoring and updating this Plan.
- Communicates with members of the program leadership team on a regular basis to ensure compliance with regulatory agencies; Attends monthly ABH Corporate Compliance Meetings and share learnings with program colleagues. Monitors privacy policies; responsible for maintaining up to date electronic health record and medical billing policies.
- Contract service management.
- Provides initial analysis, contributes to program design, and assists with program implementation on Special Projects, including but not limited to: BHCP SDH Consortium, property management software-with the Senior Director of Behavioral Health; 3 rd Party Billing Expansion opportunities; 3rd party payor contract monitoring; and other projects as assigned. HIPAA Privacy Officer: Serves as the designated HIPAA Privacy officer for the following programs: Housing Placement Programs, Stabilization, Safe Haven and Housing Support Services. Provides HIPAA/Confidentiality Training to staff as required/needed per/contract requirements.
- Provides clinical supervision to the social worker on the Housing Placement Program.
- Provides regular in-person supervision to all direct reports, and delegates and supervises work as appropriate. Coaches staff in all performance, compliance, and other issues impacting the performance of their duties. Coaches and supports staff in obtaining training necessary to the performance of their job, and in support of their career development.
- Ensures the enrollment and billing of Mass Health's CSPECH Program for Pre-Tenancy Supports. Works with the Director of the Housing Placement Program to ensure contract and regulatory compliance.
- Adheres to a professional code of ethics.
- Coordinates initiatives and special projects as assigned by the Senior Director of Behavioral Health and/or the Chief Operating Officer.
SUPERVISION TO BE EXERCISED (number of direct reports): (1) Medical Billing Coordinator- Weekly supervision; (1) Coordinator of Special Housing Initiatives; (1) Team Specialist; (1) EHR Specialist (1) biweekly clinical supervision consultation to social worker in the PMH program.
SUPERVISION TO BE RECEIVED: Bi-weekly supervision from the Senior Director of Behavioral Health.
SUPERVISORY LINE: Senior Director
of Behavioral Health, Chief Operating Officer, President and Executive Director