UM/EDI Data Technician-Ottawa County

Job Description

Job Title: UM/EDI Data Technician

Company: Ottawa County

Location: Holland, MI

Pay: $24.04 – 31.25 per hour

AI Pay Analysis: The hourly rate of $24.04 to $31.25 for a “UM/EDI Data Technician” in Holland, MI, appears to be competitive based on industry standards and the local job market. According to available data, the average hourly wage for similar data technician roles typically ranges from $20 to $35, depending on experience and specific responsibilities. Therefore, this pay range falls within the expected parameters, potentially skewing towards the lower to mid-range, acknowledging that variations can be influenced by factors such as company size, industry sector, and specific technical skills required. Overall, this compensation is reasonable for the role in that geographic area, suggesting that it may attract qualified candidates while remaining aligned with local market trends.

Job description:

Job Description
Position: Utilization Management/Electronic Data Interchange Technician

Reporting to the CMH IT Business Analyst, the Utilization Management/Electronic Data Interchange Technician will coordinate and execute encounter reporting functions essential for adhering to internal and external data reporting obligations set forth by regulatory and oversight entities. This role ensures that comprehensive processes for claims and encounter data reporting are established and maintained, and that all Utilization Management reports are effectively prepared for the Utilization Management Committee. The Technician will also support the development and enhancement of information systems that aid in data collection, analysis, and the refinement of reporting processes. Additionally, this role assists in fulfilling the reporting requirements of external regulatory and accreditation bodies.

This is a full-time position with benefits, located at the James Street Campus in Holland. Typical working hours are Monday through Friday, from 8 AM to 5 PM.

Essential Job Functions

• Generate and analyze reports related to Utilization Management and other financial metrics to assess utilization costs and provide recommendations for rate adjustments.
• Coordinate and ensure the timely submission of claims and encounter data reports to MDHHS, including ongoing monitoring for data accuracy and compliance. Communicate any noncompliance issues to the relevant teams.
• Develop management reports from the Electronic Health Record (EHR) system and other data sources, including finance (ERP) systems, collaborating with various programs and committees to create effective reports.
• Synthesize data from multiple sources and information systems to produce comprehensive reports and visual data presentations.
• Support CMH in collecting essential information critical to decision-making related to care quality, service utilization, outcome reporting, and rate-setting.
• Act as a technical authority on data quality measures and outcome reporting, engaging in various committees and workgroups such as the UM Committee, CMH Clinical Teams, Crystal Report Writers Workgroup, and Data Mapping Workgroup to enhance data quality and performance improvement initiatives.
• Assist in defining data specifications and requirements for CMH IT staff, responding to data needs that arise from multiple teams, external agencies, MDHHS, and PIHP, particularly in relation to process enhancements and quality improvement projects.
• Offer recommendations and insights to operationalize initiatives aimed at improving business operations and clinical practices.
• Serve as the primary point of contact for generating and preparing reports for external standards reviews, audits, and data submissions to agency partners and the PIHP concerning Utilization Management.
• Assist in the development of procedural manuals for new initiatives related to performance improvement and overall agency operations. Maintain and monitor the annual Utilization Management Plan.
• Participate in various state and PIHP workgroups to stay updated on changes regarding encounter code updates and new MDHHS code requirements, including the EDIT state workgroup.
• Contribute to the Medicaid Verification Review process and analyze CMH service utilization. Act as a Utilization Reviewer (UR) for CMH, ensuring the appropriateness of codes used and the credentialing of service-providing staff.
• Analyze systemic data entry and accuracy challenges and collaborate with teams and programs to develop solutions.
• Perform additional related tasks as required.

Required Education, Training, and Experience
A Bachelor’s degree in a relevant field such as Business Administration, Computer Science, Data Science, Data Analytics, or Statistics, along with one to two years of experience in mental health management or administration, or a combination of education and experience deemed equivalent. Familiarity with Medicaid/Medicare services utilization analysis is preferred. A valid Michigan driver’s license is required. Lived experiences with mental illness, developmental disabilities, or substance use disorders are valued.

Additional Requirements and Information

Required Knowledge and Skills:

• Proficient understanding of relational database design and functions.
• Exceptional analytical abilities with a strong aptitude for data and process analysis.
• Extensive knowledge of current data analysis and reporting technologies, such as Crystal Reports and SQL Server Reporting Services.
• Proven ability to extract data from various database systems and effectively present pertinent information.
• Skilled in utilizing problem-solving techniques to address complex issues.
• Demonstrated ability to collaborate effectively with groups and colleagues.
• Strong capacity to work independently and take initiative without supervision.
• Willingness to acquire new skills and engage in continuous internal and external training and professional development.
• Excellent communication skills, particularly in writing.
• Strong organizational and time management capabilities.

Physical Requirements:
The candidate must be able to perform essential job functions with or without reasonable accommodations, including the use of visual and/or audio logical devices to enhance mobility.

Working Conditions:
The role is primarily office-based.

Ottawa County is an Equal Opportunity Employer. This position is part of the AFSCME bargaining unit and comes with benefits. Ottawa County offers a wide array of benefits to support your career development.

Job Posting Date: Thu, 31 Oct 2024 04:53:29 GMT

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