Miami Jewish Health Systems CSD (Community Service Division)
Position of Business Manager is to ensure smooth back office operations and maintain the business aspects of the non-for profit agency successful. Roles being accomplished are a combination of System Administrator/IT, MIS/Data director, Vendor relations representative and Finance manager positions.
- Selected as one of 5 Task Force members for data migration and transition to new case management software representing more than 80 users and all department functions.
- Refine and maintain software application (GO! Systems- IBM Lotus Notes) functionality and database integrity for over 80 users across five databases.
- Collaborated with software vendor to develop, test, and implement software enhancement projects saving ongoing staff hours with minimal programming costs.
- Created more than 5 specialized views for purposes of reporting and data validation saving 40 hrs and $5,000 in software programming charges.
- Provide technical assistance and serve as In-House tech support for staff of more than 80 people.
- Assess business and clinical processes within software system. Made successful recommendations for system and process refinement decreasing task completion times.
- Coordinate monthly schedule for seven adjudication staff and processing of bills for 600
- Supervise staff of 3 adjudicators processing bi-weekly claims of over $1.3 Million
- Review all vendor check requests and backup for accuracy; approve check requests for payment.
- Perform weekly maintenance of views containing data exceptions. Review data for accuracy.
- Use GO! Systems-IBM Lotus Notes, ACCESS, and Crystal reports to gather revenue and expense information for programs with yearly budgets over $24 million.
- Prepare and submit monthly and/or quarterly reports for Department of Elder Affairs (DOEA), CSD Staff, and MJHS Accounting Department as required by state contracts.
- Revenue procurement exceeding $24 million for three Medicaid related programs in one year. Review payments worth $2.2 million a month for three grant programs.
- Ensure accurate monthly capitation reimbursement for more than 1900 program enrollees, prepare monthly reconciliation report of claims paid and submit report to Dept. of Elder Affairs. Generate/submit monthly enrollment and disenrollment files (834 format) to Dept of Elder affairs for more than 900 enrolled clients. Create/submit 837P files for 3 programs (Channeling, Project Independence, Douglas Gardens Comm. Care) for capitation and fee-for-service reimbursements from DOEA and grant programs.
- Review, research and correct denials on monthly Remittance Advice, decreasing denials from $282k denials monthly to $17k of denials.
- Maintain Aging Report for open AR; discussed status and recommended course of action with Supervisor to decrease $3 Million owed for two programs to less than current open AR of $245,000, collecting in total more than $2.75 million.