OPS Operations Analyst II - 64858619

Ops Operations Analyst II

This is a medically oriented OPS staff position. This position reports to the Division of Children's Medical Services, Safety Net Program (SNP) supervisor. This position is responsible for the screening and eligibility determination of children eligible for the services for the Safety Net program. Work includes performing a variety of clerical duties that require independent judgement, effective communication, accuracy, and organizational skills. The individual in this position is expected to adhere to specified timeframes and deadlines. This position provides support to the CMS Safety Net Program.

• Effectively uses FLMMIS, CMS 3.0, VIDA, and other necessary data information systems to determine program eligibility status.

• Receive correspondence requesting SafetyNet via email or telephone.

• Contacts parent/guardian to begin Safety Net application process.

• Explain Safety Net Program, verify insurance, clinical diagnosis, and determine needs. Verify accuracy of documents received.

• Resolves non-clinical issues which includes verification of eligibility and general contact information.

• Routes calls to clinical eligibility staff to conduct clinical screening as appropriate.

• Escalates calls and/or emails using appropriate chain of command based on the urgency of the issue.

• Processes referrals and applications for Safety Net, ensuring appropriate documentation of activities and quality assurance reviews.

• Documents in accordance with established guidelines while using the current electronic medical record program.

• Process Safety Net Financial Eligibility Worksheet

• Calculate proof of parent/guardian income and uses Financial Eligibility Worksheet chart to determine annual federal poverty level.

• Confirm client primary and secondary diagnosis to ensure information matches on Safety Net checklist and signed application.

• Determine client Clinical Risk Group and family cost share amount.

• Process Safety Net Financial Responsibility Agreement

• Download Federal Poverty Level annually and as needed.

• Serves as a community resource professional in the specialized medical field of pediatrics.

• Attends meetings and conferences directly related to roles and responsibilities.

• Performs other duties as assigned.

Required Knowledge, Skills, and Abilities:

• Knowledge of organizational procedures, policies, practices, rules and regulations.

• Ability to plan, organize and coordinate work assignments.

• Ability to meet deadlines and prioritize tasks effectively.

• Ability to communicate effectively verbally and in writing to express facts and ideas in a succinct and organized manner.

• Ability to effectively communicate clinical information with medical practitioners.

• Knowledge in medical terminology and procedure codes.

• Ability to establish and maintain effective working relationships with others.

• Working knowledge of Microsoft Word, Excel, and other software.

• Must be able to multitask.

• Must be an active listener and ask questions as appropriate.

Qualifications:

Minimum + High School Diploma + Driver's License Preferred

Experience in Medical setting, Medical Terminology, Pediatrics

The Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. As an OPS employee, the benefits below are available:

• State of Florida 401(a) FICA Alternative Plan (mandatory)

• Participation in state group insurance (upon meeting eligibility requirements. Consult with People First and/or the serving HR office)

• Workers' Compensation (mandatory, if needed)

• Reemployment Assistance (Unemployment Compensation) (mandatory, if needed)

• Deferred Compensation (voluntary)

• Employee Assistance Program (voluntary)

• And more! For a more complete list of benefits, including monthly costs, visit www.mybenefits.myflorida.com.

Please be advised:

Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process. This position requires a security background check and/or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration.