Quality Program Specialist - Temp
About The Position
Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. The Quality Program Specialist will work directly with internal PacificSource Risk Adjustment team processing all medical record requests in a timely and efficient manner ensuring accuracy and providing the highest quality medical record. The Quality Program Specialist must always safeguard and protect the patient’s right to privacy by ensuring that only authorized individuals have access to the patient’s medical information and that all releases of information follow the request, authorization, PacificSource Health Plans company policy, and HIPAA regulations.
Requirements
- 2 years of experience in the health insurance or medical industry required or equivalent education/experience.
- High school diploma or equivalent required.
- General knowledge and understanding of medical terminology, ICD-10-CM, CPT, and health insurance.
- Ability to review, evaluate and present quality medical records and reports.
- Good organizational skills with experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, and audio-visual equipment.
- Must have strong analytical and problem-solving skills.
- Ability to effectively communicate with all levels of staff and management.
- Must be self-motivated, organized, and detail oriented.
- Ability to work independently with minimal supervision.
- Stoop and bend.
- Sit and/or stand for extended periods of time while performing core job functions.
- Repetitive motions to include typing, sorting and filing.
- Light lifting and carrying of files and business materials.
- Ability to read and comprehend both written and spoken English.
- Communicate clearly and effectively.
Nice To Haves
- Experience with Medicare preferred.
- Associate degree preferred.
- Knowledge/experience with Medicare quality programs (CMS 5-Star, HEDIS, risk adjustment) preferred.
Responsibilities
- Receives incoming requests for medical records and responds to request in timely and efficient manner ensuring the correct medical record is obtained and valid for risk adjustment review purposes.
- Validates requests and authorizations for release of medical information according to established procedures and HIPAA guidelines.
- Performs quality check on all chart retrieval workbooks to verify accuracy of the records before submission to coding.
- Ability to work with minimum supervision, organize workload and prioritize work tasks to meet production goals.
- Communicates with Manager on an on-going basis, providing information and data as requested including retrieval feedback needs and requests.
- Promptly reports to Manager any customer service concerns and/or any potential HIPAA violations whether actual or perceived.
- Management of member records including file storage that’s in alignment with HIPAA laws and regulations and in compliance with Business Associate Agreements.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
Benefits
- Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
