Hospice Quality Assurance Administrator

Graham Healthcare Group

6d • Remote

About The Position

Graham Healthcare Group is hiring a Hospice Quality Assurance Administrator to join our dynamic team! The Hospice Quality Assurance Administrator will provide support to the Quality department and Clinical Operations teams under the supervision of the Director of Regulatory and Quality Assurance and Hospice QA Manager.

Requirements

• High school diploma or equivalent, some college coursework preferred
• Knowledge of Medicare Part A, B, and D coding processes, medical terminology, clinical documentation, legal aspects of health information, health data standards, and classification conventions
• Knowledge of the HCHB program preferred
• Working knowledge of Medicare Part D plans and prior authorizations
• Knowledgeable in medical terminology, pharmacology, and the insurance pre-authorization process
• Understanding of various medical insurance processes
• Ability to read and follow written instructions and document
• Verbal and written communication skills and exceptional problem-solving skills
• Maintains contact with internal and external Customers (patients, families, administration, nursing, and physicians), emphasizing commitment to quality of service

Nice To Haves

• Pharmacy Technician certification preferred
• Medical Assistant certification preferred

Responsibilities

• Meet quality and productivity standards and deadlines/turnaround times established by Hospice
• Perform daily HCHB workflow maintenance to ensure the medical record is compliant and up to date
• Review and compare daily reports to clinical staff documentation
• Review Medicare Part D response and denials documents and collaborate with the physician and clinical supervisors for accuracy
• Maintain working knowledge of Brand and Generic Medications for Hospice Patients and work collaboratively with Part D Sponsors to ensure correct payment for medications
• Collaborate with the Billing Department to ensure claims are complete with the appropriate medications.
• Perform claim medication review and entry of claim medications into the medical record
• Perform data entry of medications dispensed by the pharmacy and monitor the HCHB interface
• Ensure accurate and timely submission of HIS data and keep current on changing rules and regulations as related to HIS
• Communicate with the various insurance companies to ensure proper processes are being met, and ensure payments are correct
• Assist, when necessary, with planning and scheduling face-to-face visits with Nurse Practitioners and Hospice physicians to maintain compliance
• Perform Quality Assurance audits as directed

Benefits

• Competitive Pay: With opportunity for advancement
• Health and Welfare Benefits: Various medical, dental, and vision insurance options for you and your family to choose from.
• Supplemental Benefits: Company-paid life insurance and disability benefits. Also, pre-tax FSA and HSA plans are offered.
• Generous PTO Packages.
• Retirement: Save for your future with our company offered 401k plan and pension.
• Company-Paid Education Programs: Grow your career by taking advantage of 50% discounts on tuition for selected courses offered by Purdue and Kaplan.
• Benefits may vary based on your employment status.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED