UM/EDI Data Technician

(Utilization Management/Electronic Data Interchange Technician)
Under the direction of the CMH IT Business Analyst, coordinates and performs encounter reporting functions related to the internal or external data reporting requirements to oversight bodies or other external regulatory groups. Assures that all processes related to claims and encounter data reporting are in place. Assures that all Utilization Management reports are in place for Utilization Management Committee. Assures that information systems are in place to assists in data collection, analysis and improving data processes and reporting. Assists in meeting reporting requirements of external regulatory and accreditation bodies.

This is a full-time benefited position, based at the James Street Campus in Holland, and the typical working hours are M-F, 8A-5P. 

1. Create reports, review and analyze data reported for Utilization management and other financial reports useful to determine utilization costs such as make recommendations for rates.
2. Coordinate and ensure that processes are in place for claims and encounter data reports to MDHHS in a timely manner. This includes monitoring for data accuracy and compliance requirements are met. Communicates areas of noncompliance to appropriate team.
3. Develop management reports from the EHR (Electronic Health Record) system as well as other sources of information such as finance (ERP) System. Works with various programs and committee to design and develop reports.
4. Integrate data points from various sources and information systems for report generation and data visualization.
5. Assist CMH in gathering pertinent information critical for decision making as it relates to quality of care, utilization of services, outcome reporting and rate-setting.
6. Serve as a technical expert on data, quality measures, and outcome reporting on various committees and workgroups such as the UM committee, CMH Clinical teams, Crystal Report Writer's workgroup and Data Mapping workgroup. Coordinates efforts to improve data quality and performance improvement efforts.
7. Assist and provide data specifications and data requirements to CMH IT staff as data needs arise from various teams at CMH, external agencies, MDHHS, and PIHP-- such as new initiatives related to process improvements, clinical improvements and quality improvement projects.
8. Make recommendations and provides input in operationalizing initiatives to improve the business operations as well as the clinical practice as a whole.
9. Act as the lead and point-of-contact in generating and preparing reports for external standards reviews, audits and data submission to agency partners and the PIHP as it relates to Utilization Management.
10. Assist and develop procedural manuals for new initiatives as it relates to performance improvement and the agency as a whole. Maintain and monitor an annual Utilization Management Plan.
11. Participate in various state and PIHP workgroups to stay informed on changes in encounter code updates and new MDHHS code requirements such as the EDIT state workgroup.
12. Assist in the Medicaid Verification Review process and derive insight into CMH service utilization. Serve as UR (utilization reviewer) for CMH and ensure that codes used are appropriate and that staff providing the services are credentialed.
13. Perform analysis in determining systemic data entry and accuracy issues and work with teams and programs to find solutions.
14. Perform other tasks as required.

Bachelor's degree in a relevant field such as Business Administration, Computer Science, Data Science, Data Analytics, and/or Statistics, with one to two years experience in mental health management or administration, or an equivalent combination of education and experience. Knowledge and experience in analysis of Medicaid/Medicare services utilization is preferred Possession of a valid Michigan driver's license is required. Lived experiences with mental illness, developmental disabilities, or substance use disorders are valued.REQUIRED KNOWLEDGE AND SKILLS:

1. Thorough working knowledge of relational database design and functions.
2. Excellent analytical skills and ability to analyze data and processes.
3. Excellent working knowledge of current data analysis and reporting technologies such as Crystal Reports and SQL Server Reporting Services.
4. Demonstrated knowledge and ability to extract data from various database systems and display relevant information.
5.  Ability to utilize problem solving methods to solve complex issues.
6. Demonstrated ability to work effectively with groups and colleagues.
7. Ability to take initiative and work well without supervision.
8. Willingness to develop new skills and take regular advantage of internal and external training and staff development opportunities.
9. Good communication skills, especially excellent writing skills required.
10. Good organizational and time management skills.

PHYSICAL REQUIREMENTS:
Must be able to perform essential job functions with or without reasonable accommodations, including,
but not limited to, visual and/or audio logical appliances, and devices to increase mobility.

WORKING CONDITIONS:
Work is performed in an office environment
 

Salary : $24 - $31