Implementations Quality Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES

• · Responsible for auditing all aspects policies and procedures, including assisting in their development, implementation, training, monitoring compliance and giving corrective action.
• · Regularly audit accounts to ensure maximum efficiency and productivity levels.
• · Exemplify, influence, and encourage implementation of all standards and procedures.
• · Identify, compile, document and report trends and issues to management.
• · Provide direction and recommend improvements to enhance business processes and practices.
• · Collaborate with management and other departments as necessary to minimize and/or resolve ongoing procedural problems affecting Client satisfaction/quality standards.
• · Promptly inform manager of any matters that may cause a disruption to any Client(s), impact revenue, or violate compliance policies.
• · Manage client audit schedule and maintain audit tracking log; consistently meet or exceed monthly audit goals
• · Manage and maintain confidential and proprietary Elevate PFS and client information.
• · Participate in corporate training to enhance performance and knowledge.
• · Offer ideas to improve audit processes.
• · Screen uninsured hospital patients in an effort to determine if patient is a viable candidate for federal, state, and/or county medical or disability assistance.
• · Complete the appropriate applications and following through until approved
• · Detailed, accurate and timely documentation in both MPower and the hospital systems on all cases worked
• · Provide exceptional customer service skills at all times
• · Participate in ongoing trainings in order to apply the content learned in dealings with patients and cases
• · Maintain assigned work queue of patient accounts
• · Answer incoming telephone calls, make out-bound calls, and track (via MPower) all paperwork necessary to submit enrollment and renewal for prospective Medicaid patients.
• · Maintain structured and timely contact with the applicant and responsible government agency, by phone whenever possible or as structured via the daily work queue.
• · Assist the applicant with gathering any additional reports or records, meeting appointment dates and times and arrange transportation if warranted
• · Request home visits as needed to acquire documentation
• · As per established protocols, inform the client in a timely manner of all approvals and denials of coverage
• · Participate in additional training requirements in an effort to stay abreast of the ever-changing rules and regulations associated with the various governmental programs
• · Performs other related duties as assigned.

QUALIFICATIONS AND REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.

• · Ability to interact with tact and diplomacy with individuals from a variety of backgrounds and organizational levels.
• · Ability to effectively communicating in writing and verbally.
• · Excellent organizational, planning, and prioritization skills.
• · Knowledge of: Gold Standards, Elevate PFS’s service lines, HIPAA, ACA and EMTALA regulations, Medicare/Medicaid Regulations, Medical Terminology
• · Skilled In: MPower, Outlook, Ring Central, Excel, Word, PowerPoint, Visio
• · Ability to interpret and analyze data, multitask, work independently, prioritize, troubleshoot, problem solve, direct others, communicate clearly and effectively across different organization levels, functions and geographies both internally and externally to realize needs and provide solutions, expand ideas and thought processes with global approach in all areas. Independent decision-making is critical.
• · Resourceful, detail oriented.
• · Demonstrate flexibility to work on competing priorities.
• · Able to identify patterns, make informed decisions, correctly diagnose root causes to determine appropriate actions and outcomes.
• · 5+ years Office experience in which problem solving and research were major keys to success.
• · Prior computer experience is required. Experience with hospital systems a plus.
• Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.