PROJECT SPECIALIST - HEALTHCARE - REMOTE

MICHIGAN PEER REVIEW ORGANIZATION• REMOTE, US,

10d•$50,000 - $60,000•Remote

About The Position

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, recognized as a Cool Place to Work and one of Modern Healthcare’s Best Places to Work in Healthcare. As a nonprofit with over 40 years of experience, they are dedicated to improving healthcare using evidence-based, data-driven strategies. They provide consulting, review services, and data analysis to various healthcare entities. This position is 100% remote, allowing work from anywhere in the United States, and offers a focus on work/life balance, professional development, and continuing education. The company's mission is to improve the quality, safety, and efficiency of healthcare by partnering with providers to promote evidence-based best practices.

Requirements

Associate’s degree or five (5) years of related experience required
Minimum two (2) years of project support experience in a corporate or professional environment required.
Project management skills required.
Strong communication skills, both verbal and written, required.
Strong multi-tasking skills with attention to detail and deadlines required.

Nice To Haves

Bachelor’s degree preferred (healthcare specialty preferred).
Experience in IDR or claims, appeal, and denial processes preferred.

Responsibilities

Assist the team with facilitating review requests in a timely and efficient manner, including implementing processes to track and monitor individual case progress and timeliness.
Collaborate with IDRE team members to achieve department goals, including prescreening IDR (Independent Dispute Resolution) cases for eligibility using defined criteria.
Apply knowledge and experience in claims, appeals, and denials to support review and resolution processes, ensuring accuracy, compliance, and timeliness.
Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review and claims-related portals.
Work closely with the administrative assistant to ensure receipt and completeness of all review documentation.
Develop materials such as forms, email correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity.
Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events.
Utilize advanced computer skills for daily work; responsibilities require constant computer usage and proficiency in software programs such as Microsoft Office, all Windows software products, and web-based portals.
Participate in portal development and enhancements, including testing and feedback to improve functionality and user experience.
Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR)).
Complete other duties as assigned