Quality Support Specialist

Kintegra Health•Gastonia, NC

16h

About The Position

UNDER THE DIRECTION OF THE QUALITY & COMPLIANCE MANAGER, THE QUALITY SUPPORT SPECIALIST WILL WORK WITHIN THE DEPARTMENT TO PROVIDE ORGANIZATIONAL ADMINISTRATIVE ASSISTANCE. RESPONSIBLE FOR WORKING INDEPENDENTLY & PROACTIVELY TO COMPLETE RESPONSIBILITIES IN AN APPROPRIATE & TIMELY MANNER. REQUIRES DISCRETION IN WORKING WITH CONFIDENTIAL INFORMATION & SENSITIVE MATERIAL. RESPONSIBILITIES INCLUDE PROGRAM SUPPORT, ADMINISTRATION TASKS & COORDINATING PARTICIPANT GRIEVANCE RESOLUTIONS. POSITION REPORTS DIRECTLY TO THE QUALITY & COMPLIANCE MANAGER.

Requirements

Precise attention to detail; must be highly organized with an ability to efficiently prioritize tasks
Ability to meet multiple deadlines within a strict time limit & problem solve in a prompt manner
Ability to manage time wisely
Exceptional internal & external customer service skills
Proficient with Microsoft Office applications including Word, Excel, SharePoint, and PowerPoint.
Ability to coordinate multiple duties simultaneously
Capable of learning new tasks quickly & efficiently
Ability to function successfully independently and within a team environment.
Solid analytical & logical skills.
Capable of solving problems & working independently
Demonstrates accountability
Excellent written & verbal communication skills
Ability to follow written & verbal instructions
Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact

Nice To Haves

Background in health, quality, compliance, business intelligence or data science is a plus.

Responsibilities

Tracks & manages time-sensitive tasks.
Supports the Interdisciplinary Teams and Quality Department by maintaining an organized workflow.
Completes special projects in a timely manner utilizing advanced computer skills.
Prepares & distributes service determination request (SDR) denial (includes partial denial), appeal decision letters, denial of enrollment, and involuntary disenrollment letters for all programs.
Uploads all adverse and appeal decision letters to PCG for all programs.
Gathers documents needed for internal appeals and notifying the Quality Coordinator of preparation to be sent to the review PACE organization for all programs. Assists assigned team members with appeal decision notifications and documents within the EMR/EHR for all programs.
Gathers documents for external appeals shared from the Quality Coordinator, saves documents on the shared drive. Coordinates a review team to review the appeal and make a decision (scheduling with review team and participant or designated representative, providing documentation, assisting with questions, etc.). Completes appeal decision written notice letter and provides to the Quality Coordinator to distribute to the original PACE organization. The above external appeal tasks are for all programs.
Completes, mails, and documents in the EHR grievance written notifications when needed for all programs.
Effectuates the administrative tasks for the Featured Friday program by overseeing the weekly text questions for all programs. Notifies each Quality Coordinator of monthly winners for special recognition at the program level.
Reviews and updates QI Committee Meeting Minutes monthly using AI/Copilot. Disseminates to each Quality Coordinator for final review and sharing with each committee.
Supports each Quality Coordinator with needed administrative tasks during quality projects.
Provides administrative support for policy management.
Supports Senior TLC’s mission to encourage & support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; & its values of respect, integrity, accountability, compatible goals, & compassionate care.
Other duties as assigned.