Quality Coordinator (Part C)

Tmf/C2C • Austin, TX

9d • Remote

About The Position

Ensures decision makers adjudicate cases accurately by performing quality audits, reviews, and publishing audit results and conducting meetings, providing coaching, and training on quality. Works under limited supervision, with considerable latitude for the use of initiative and independent judgement.

Requirements

• Associate's degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
• Three (3) years medical dispute, Medicare appeals or clinical experience in a healthcare setting
• Two (2) years of training
• Managed Care Healthcare Professional with demonstrated experience writing or making medical necessity decisions
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Nice To Haves

• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
• Medicare Part C related appeals activities

Responsibilities

• Performs audits to ensure timeliness, accuracy, and consistency in reconsideration/dispute resolution decisions.
• Participates in planning, preparing, and facilitating discussion for regularly scheduled process and program improvement meetings.
• Oversees, provides and plans training for new and current staff, including developing and presenting presentations, quality tips, and decision consistency memos.
• Participates in special projects and performs other duties as assigned.
• Performs audits and examinations of case files to identify inaccuracies and non-compliance issues.

Benefits

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree