Optical Billing and Website Maintenance Services

The Vendor is required to provide electronic billing services for medical claims and annual website maintenance services for its optical online ordering system.
- There is a close relationship between the electronic billing function services for Medi-Cal claims and the information technology behind agency optical ordering website known as POOLS (PIA Optical On-Line Systems).
- To maintain audit compliance and ensure electronic Medi-Cal billing integrity, the Contractor must have thorough understanding of Medi-Cal billing requirements and possess the information technology (IT) knowledge of the POOLS website to be able to make adjustments.
- Furnish all labor, including travel and per diem, materials, nonconsumable supplies, parking fees and bridge tolls, insurance, transportation, equipment and every other item of expense necessary to perform services.
- The file will contain orders created by our Medi-Cal providers and contain manufacturing information for Rx’s needing to be processed.
- The Rx information will contain patient’s name, Medi-Cal identification number, sex, birth date, control number, provider account number, ship date, country code, aide code, and all other production information that will allow Contractor to process billing of each other.
- Only Medi-Cal prescription information will be processed.
- Prescription data coding has over 100 possible codes describing different aspects of eyeglass fabrication and requires knowledge to translate data and produce codes for billing procedures.
- Coding considers dioptric power identification for spheres and cylinders, material used, tints, applicable lens coatings, prisms and lens types including slab off, myodisc and lenticular lenses in addition to single vision, bifocals, trifocals and balanced lenses.
- Provide, but not limited to, any report needed for management of administration of optical programs.
- Maintenance requests received after 3:00pm PST may not be completed until the next business day unless prior arrangements have been made.
- Project Management:
•    Lead complex projects with minimal oversight.
•    Determine project scopes, milestones, tasks, risk, objectives, and dependencies. Ensure projects are delivered on time, within budget, and according to specifications.
•    Perform resource allocation and work assignments and monitor deliverable deadlines.
•    Create and revise scope of work (work plans, deliverables, and team resources). Create timetable, including delivery dates (project plan) for business process analysis, system configuration, training, project meetings, data conversions/interfaces and other project deliverables or milestones.
•    Schedule and facilitate ongoing project status meetings with Contractor and project team.
•    Ensure effective and creative idea generation among the project team.
•    Act as contact for key client executives and management (business and/or technical).
•    Work with project staff to define and manage all contractual project requirements.  Prepare and maintain documentation of any programming changes.
- Application Development:
•    Determine Application change requirements working with agency Operations staff.
•    Develop requirements and flow charts; schedule and facilitate Joint Application Development (JAD) session.
•    Finalize Application Development design and schedule start date for work.  Prioritize, schedule, and approve “new” Application Development work.
•    Monitor and manage Application Development efforts; ensure specifications and timelines are being met.
•    Perform User Acceptance and Testing.
•    Manage and coordinate requests for changes from original specifications.  
•    Manage and perform quality assurance testing.
•    Track and report on quality assurance metrics.
- Systems Support:
•    Design and test systems backup strategy and recovery plans.
•    Monitor and manage system backups, database backups and system imaging.  
•    Monitor and implement operating system and application release updates and patches.
•    Manage all support for the “Development Server”.
•    Take corrective action to resolve hardware, software, or application failures.  
•    Manage SQL Database and make changes as required.
•    Troubleshoot issues and work with the customer and management to implement positive solutions, identifying the data necessary to prove test conditions. 
- Operations Management:
•    Recommend appropriate process and procedure revisions where needed.  
•    Provide technical support to Optical Annex, Medi-Cal Providers, and Labs.  
•    Work closely with Department to ensure the Optical Program is in compliance with Medi-Cal regulations.
•    Provide information and support to agency online Medi-Cal Provider community as requested.
- Infrastructure Support:
•    Provide problem solving in SQL.
•    Have cursory knowledge of VB.net, JavaScript, HTML, and ASP.net.

- Contract Period/Term: 3 years