Quality Management Assistant

Job Description

Job Description

Duties:

1. Provides general non-clinical assistance to the QM Director/Compliance Officer and the QM Clinical Analyst such as maintain spreadsheets, faxing, copying, scanning and file maintenance.
2. Medical Record Requests: receives and logs requests, obtains necessary authorizations for release of PHI, prints record for QM clinical review. Works collaboratively with Accounts Receivable to prepare invoices and ensures fees are collected and records are released after receipt of payment.
3. Receives Medicare Notices of Non-coverage and Patient Acknowledgement forms from field staff and processes related workflow in HCHB. Reviews forms for proper completion and provides feedback to clinician and/or Directors of Nursing/Rehab regarding errors or omissions.
4. Conducts compliance and quality related auditing as assigned by the QM Director/Compliance Officer. Auditing includes but is not limited to patient signature audits, visit time auditing, HHA vendor exception auditing, HHA conflict resolution. Auditing includes compiling related reports and providing feedback to staff and vendors as applicable.
5. Assists the QM Director/Compliance Officer with vendor related activities including but not limited to new contract management and vetting, obtaining insurance certificates, wage parity certifications and yearly update of vendor personnel contact lists. Maintains spread sheets and files accordingly.
6. Assists QM with Medicare Expedited appeals: logs request, obtains necessary documents from staff, forwards to the QIO, prints chart and sends chart to QIO if requested. Tracks status and response to appeal.
7. Assists QM Director with tracking and correspondence on lawsuits.
8. Utilization Review: Identifies charts for review under guidance of QM Clinical Analyst. Assigns charts to reviewers. Ensures all paper documents are available for review. Assists QM Dept. to ensure reviews are completed in the time frame allotted and gives reports to Director/Manager.
9. Incident reporting: assists QM with logging and tracking receipt of written incident report from the clinical staff. Works with QM to ensure reports are reviewed and complete.
10. Assists QM Director/Compliance Officer with Professional Advisory Committee and Compliance Committee preparation including meeting set up, invitations, PowerPoint’s and handouts and minutes.

Other related duties in the Quality Management/Compliance Department