Job Description
Community Resource Network of Florida is a premier provider of services to Individuals with Developmental and Intellectual Disabilities throughout the state of Florida. Our person-centered approach is tailored to each Individual with the goal of helping them reach their personal goals and become as independent as possible in the community. We serve both adults and children with compassion. This role is in our In- Home services department, specifically working with families who are seeking services for their children and assisting families that receive services for their children. This is a part in person, part remote position. Hours are standard business hours Monday-Friday, no weekends! Ideal candidate will have experience in a licensed home health agency or other Medicaid funded service agency. Prior experience working with Individuals with I/DD a plus. Spanish and English-speaking skills a must.
ROLE OF THE PERSONAL CARE SERVICES SPECIALIST
The Personal Care Services Specialist is responsible for coordinating the services CRN provides under the licensure requirements set forth by AHCA and in accordance with the contract requirements of each payer.
The Personal Care Services Specialist works as a liaison between the PCS Manager, billing, pay and operations department to ensure communication regarding authorizations and other payer requirements. This role works in coordination with physicians, case managers, insurance payers and others to obtain initial and maintain on-going services.
ESSENTIAL FUNCTIONS 1. Administration/Compliance Ensure personal care services provided are in compliance with AHCA licensure and contract requirements for each payer.
- Act as a liaison between the PCS Manager, billing, payroll, and operations to facilitate communication regarding authorizations and payer requirements.
- Assist in the documentation and maintenance of policies to remain compliant with ASPEN standards for state surveys.
- Maintain logs, drills, minutes or other documentation required to demonstrate compliance with licensure regulations and contract specifications.
- Continually work to improve quality and service delivery in accordance with the
- companies’ quality improvement plan.
- Update emergency preparedness and procedures, as required.
- Tailor system to each Individual’s needs with appropriate updates in each Plan of Care period.
- Communicate updated POC with the HHA/CNA service provider.
- Coordinate plan of care training for the HHA/CAN with the Registered per POC period, as required.
- Admit Individual and create programs for newly referred individuals into the appropriate system.
- Review documentation requirements.
- Assist with Electronic Visit Verification system training and troubleshooting.
- Assist with confirmation of EVV data – errors or missing information to ensure compliance with service delivery.
2. Authorizations - Coordinate with insurance providers, physicians, and case managers to obtain initial approvals and maintain ongoing service authorizations.
- Address any authorization or payer-related concerns to ensure uninterrupted service
- Track and update schedule changes in authorizations in appropriate system.
- Update and modify schedules per Individuals/DSP requests.
- Communicate changes to Individual receiving services as well as the HHA or CNA service provider.
- Communicate status of services to both Individuals and services providers.
- Communicate with Individual receiving services to confirm accuracy for service renewal purposes.
- Verify schedules with the family.
2. Operations and Fulfillment - Maintain accurate records of service authorizations and payer requirements
- Ensure receipt of initial intake and each POC period paperwork from Individuals served
- Maintain files of intake paperwork
- Monitor and communicate information to assist individuals with the transition into Med
- Waiver or Long-Term care services as they reach the age of 21 years.
- Communicate with referral sources i.e. nurse case managers and others to maintain relationships
3. Utilization/ Billing/Pay Liaison - Work closely with internal departments to streamline processes and improve service efficiency.
- Collaborate with billing department for utilization that is out of parameter.
- Communicate with service provider and/or Individual served when hours out of sync with authorized amount.
- Documents all communication with Individuals served, and service providers regarding utilization parameters.
- Investigate and resolve underutilization or no utilization to ensure customer service.
- Communicate with service provider and Individuals served any changes or modification in the service delivery or utilization parameters
- Enter and modify master schedules in the EVV system.
- Assist in trouble shooting of service provider pay issues
- Contact pay representative for matters involving service provider payments (HHA/CNA)
- Maintain and update the billing utilization spreadsheet to reflect accurate authorizations per Individual served
QUALIFICATIONS Minimum 1 year experience in a healthcare setting, or home health agency or other service business.
- Experience working with individuals with intellectual/ developmental disabilities preferred.
- Minimum 1 experience in a customer service role, either in person or via phone.
- Spanish and English speaking and writing skills, required
- HS diploma or equivalent, college coursework or degree preferred
- Must pass Level II Background screening.
- Must pass a drug screening.
- Authorized to work in the United States.
Job Tags
Full time, Contract work, Remote job, Monday to Friday,