Referral Coordinator

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

Description

The Quality Coordinator is the primary person to analyze patient chart data to confirm HEDIS measures are being met and addressed appropriately by the Physicians. This person will work closely and communicate with Insurance groups, Physicians, Medical Staff and Billing staff whether it be via fax, email, phone, US mail, or in person. The main objectives is to make sure that HEDIS GAPS are being addressed and communicating with the Physicians, Medical Staff and Senior Management on the status and issues met in their audits.

Job Duties

• Checking PCP schedules weekly and reviewing patient's charts for any outstanding HEDIS measures.
• Creating or modifying HEDIS ENCOUNTERS in patients' charts to communicate with Physicians and Medical Staff.
• Reviewing or creating various reports using Microsoft Excel. Ability to manipulate spreadsheets using features: filtering, sorting, grouping, etc…
• Reviewing/ Updating Member Lists with specific insurance groups and confirming patients have had appointments and creating call lists for those who require visits. Call lists need to be sent to Front Office Managers in each office, with deadline established and lists followed up on in a timely manner.
• Assisting with outside chart audits and submitting or required information as needed.
• Keeping a log of all chart audits and outcomes of each audit/document submission as needed.
• Submitting/reporting patient information to various health plans via their portals as directed.
• Perform other duties as may be required.

Job Requirements

Education and/or Experience

• Familiars with Medicare Advantage plans and HMO's preferred
• 2+ years healthcare/primary care experience; knowledge (electronic medical record programs),

Required Knowledge, Skills and Abilities

• Should possess good clinical skills and physiological knowledge
• Spanish speaking ability is preferred
• Ability to perform comprehensive medical histories and physical exams
• Ability to communication complex medical information to a diverse population
• Be able to work effectively as part of a team.
• Good organizing, coordination and office skills
• Customer service orientation and good phone etiquettes
• Knowledgeable about record keeping, billing, coding and reimbursement processes
• Computer literate; knowledge and skill in the operation of computer systems and applications (medical software e.g. ECW/Medisoft and productivity software e.g. MS Office)

WORK ENVIRONMENT

• All work is performed within a standard health care/primary care clinical setting

DISCLAIMER

The duties and responsibilities, qualifications, physical conditions and other statements contained herein represent the current general nature of the job described, and are subject to change at any time, with or without notice. This job description does not limit in any way the assignments that may be given to an employee in the job, and employees are expected to perform any and all duties assigned by their supervisor willingly and without reservation.

Full-Time/Part-Time Full-Time

This position is currently accepting applications.