Human Services Program Analyst

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Requisition No:866435

Agency:
Department of Health

Working Title:

HUMAN SERVICES PROGRAM ANALYST -  1

HUMAN SERVICES PROGRAM ANALYST - OPEN COMPETITIVE

This position is an Analyst within the Specialty Care Program, whose primary functions are to generate medical referrals for specialists in the Pinellas County Health and Health Care for the Homeless Plans.

• Evaluates services to achieve and maintain cost effective, quality health care. Authorized to limit services based on medical necessity and procedural guidelines. Uses professional guidelines for Specialty Care. Develops procedures to evaluate medical necessity.
• Evaluates authorization requests for specialty care referrals in accordance to the established Specialty Care medical grid(Radiology, Behavioral and other specialties)
• Verifies County eligibility.
• Generates authorization referrals for Specialty Care in accordance with established procedural guidelines in HMS ACG.
• Generates 15 Referrals daily or meets center capacity demand.
• Generates letters as needed. Faxes referrals to medical providers as needed.
• Processes stat referrals as assigned.

• Verify data requested from source documents is entered with a 95% accuracy rate.
• Review statistical reports in Logi.
• Assist the Business Operations Specialist in the development and implementation of guidelines to be used for consistent application of criteria.
• Liaisons with specialist providers requesting additional medical information as needed.

• Backs up DOH pharmacy tech to provide pharmacy services to PCHP clients as assigned, to include overrides/prior authorizations or denials.
• Access pharmacy voicemails and phone calls from medical providers as needed.
• Scans and imports medical records in accordance established standards.
• Participates in quality improvement activities, including chart review, in-service programs, and staff meetings.
• Faxes Referrals and medical records to providers.
• Submits employee activities report (EARS) in a timely manner.
• Enter services and process billing claims.
• Enters Services and tracking process for Directions Behavioral Health program, review clinical notes match claims and authorization.

• Knowledge of medical terminology.
• Knowledge of Pinellas County Health and Health Care for the Homeless Plans.
• Ability to plan, organize and coordinate work assignments.
• Ability to establish and maintain working relationships with others.
• Ability to type and/or in a keyboard control data input device and utilize other office equipment.
• Ability to follow instructions.
• Ability to review data for accuracy and completeness.
• Ability to meet and maintain minimum production requirements for speed and accuracy.
• Ability to communicate effectively both written and verbal.
• Skills in Information Technology.

3+ years Experience in a Health Care and / or a Clinical Setting

At least 1 year experince with Advanced skills in Information Technology

5+ years Knowledge and Understanding of Medical Terminology and standard abbreviations

Medical licensure

Bachelor’s Degree

To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

To be the Healthiest State in the Nation.

Innovation:
We search for creative solutions and manage resources wisely.

Collaboration:

We use teamwork to achieve common goals & solve problems.

Accountability:
We perform with integrity & respect.

Responsiveness:
We achieve our mission by serving our customers & engaging our partners.

Excellence:
We promote quality outcomes through learning & continuous performance improvement.

St. Petersburg Center; 205 Dr. M. L. King Jr. St. N., St. Pete, 33701

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