Job Description
Quality Assurance Coordinator - WORK FROM HOME (Eastern or Central Time Zone)
Job Location
US-FL-Clearwater | US-VA-Roanoke
ID
2024-3597
Category
Administrative/Clerical
Position Status
Regular Full-Time
Position Schedule
Monday-Friday
Shift
9-6
Alternative Schedule
2 late nights for month end
Overview
Are you looking for a purposeful career that will make a difference in the patient community? At CCS, our approach to at-home patient care is redefining chronic care management. We are seeking individuals that will thrive in a patient-centric dynamic environment. If you are an attentive listener, fast-thinker, and problem-solver, with the ability to relate to different people, you are a match for CCS.
As a Quality Assurance Coordinator ., you will be responsible for auditing new patient charts, recurring order queues, and other tasks to confirm adherence to payer, company/department procedures, and system integrity.
Responsibilities
Performs quality evaluations on medical and insurance records in a consistent and accurate manner
• Produces reports as needed on data accumulated during chart and order reviews
• Identifies and reports trends
• Verifies that all appropriate supporting documentation are obtained prior to shipment and/or prior to billing
• Audits configuration of supplies based on supporting documentation, formulary requirements and manufacturer compatibility
• Ensures compliance with healthcare and insurance rules, regulations and requirements
• Develops and maintains teamwork within and outside the department
• Maintains a high degree of confidentiality at all times due to access to sensitive information
• Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
• Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements
• Abides by all regulations, policies, procedures and standards
Qualifications
• High School diploma or (GED) equivalent. Two plus year of medical office/terminology experience or the equivalent combination of education and experience or six months of experience for internal candidates. Must be knowledgeable of reimbursement processes and Procedures
• PIMS knowledge a plus
• Ability to define problems, collect data, establish facts and draw valid conclusions; ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
• Ability to interpret rules and regulations set by Medicare, Medicaid, and Commercial payors
• Ability to learn and maintain a clear understanding of department process flows, procedures, and products
• Ability to communicate findings to all levels of management in the organization
• Proficient with various Microsoft Office software such as Outlook, Word, Excel and PowerPoint
• Good reasoning and multi-tasking abilities
• Knowledge of compliance guidelines, payer requirements, government regulations, and agency rules
• Planning, critical-thinking, organization, and execution skills
• Good written and verbal communication skills
• Judgment and decision-making
• Situational awareness
CCS Medical is an AA/EEO employer. M/F/D/V
Values
Values
Certainty-The lives of the individuals we serve depend on our ability to execute. We commit to doing this every day.
• Use appropriate methods and a flexible interpersonal style to help build a cohesive and collaborative team based on a foundation of trust and transparency. Deliver what you commit to.
Compassion-We understand the burdens of patients and their loved ones and channel this into a relentless pursuit of customer satisfaction in every part of our business.
• Ensure that the patient is the driving force behind business decisions, implementing service practices that meet needs of both the patient and the organization. Treat other the way you want to be treated.
Advancement-We are endlessly looking for ways to progress and become more innovative in all things we do.
• Encourage innovative approaches for addressing opportunities and facilitating change, driving cross-functional alignment to accomplish goals. Speak the truth.
CCS Medical and EEOC/AA employer. M/F/D/V
Equal Opportunity Employer/Veterans/Disabled
Compensation and Hours
Salary Range: Not Available DOE (Depends on Experience) Benefits Provided: Not Available Other Benefits: Not Available Full or Part Time: Full Time (30 Hours or More) Job Duration: Over 150 Days Type of Job: Regular
Shift: Not Applicable
Hours per Week:
Hours Not Specified
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