Quality Assurance Administrator

Job Title 

Location

Additional Location(s)

Employee Type

Working Hours Per Week

SUMMARY
Provide support to the Quality department and Clinical Operations teams under the supervision of the Director of Regulatory and Quality Assurance and Hospice QA Manager.
ESSENTIAL DUTIES AND RESPONSIBILITIES
include the following. Other duties may be assigned as necessary.
• Know and adhere to HIPAA regulations
• Meet quality and productivity standards and deadlines/turnaround times established by Hospice
• Perform daily HCHB workflow maintenance to ensure medical record is compliant and up to date
• Review and compare daily reports to clinical staff documentation
• Review Medicare Part D response and denials documents and collaborate with physician and clinical supervisors for accuracy
• Maintain working knowledge of Brand and Generic Medications for Hospice Patients and work collaboratively with Part D Sponsors to ensure correct payment for medications
• Collaborate with the Billing Department to ensure claims are complete with the appropriate medications.
• Perform claim medication review and entry of claim medications into medical record
• Perform data entry of medications dispensed by the pharmacy and monitor HCHB interface
• Ensure accurate and timely submission of HIS data and keep current on changing rules and regulations as related to HIS
• Reviews HIS data for hospice branches
• Communicate with the various insurance companies to ensure proper processes are being met ensures payments are correct
• Assist, when necessary, with planning and scheduling face-to-face visits with Nurse Practitioner and Hospice physicians to maintain compliance
• Perform Quality Assurance audits as directed
• Maintain flexibility within the performance of duties to accommodate needs of the department
• Comply with Company’s Core Values and Core Competencies
• Perform other duties as assigned
QUALIFICATION 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 ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• High school diploma or equivalent, some college coursework preferred
• Medical Assistant certification preferred
• Pharmacy Technician certification preferred
• Knowledge of Medicare Part A, B, and D coding processes, medical terminology, clinical documentation, legal aspects of health information, health data standards, and classification conventions
• Knowledge of HCHB program preferred
• Working knowledge of Medicare Part D plans and prior authorizations
• Knowledgeable in medical terminology, pharmacology, and insurance pre-authorization process
• At least 18 years of age
• Understanding of various medical insurance processes
• Ability to read and follow written instructions and document
• Attention to detail
• Verbal and written communication skills and exceptional problem-solving skills
• Maintains contact with internal and external Customers (patients, families, administration, nursing, and physicians) emphasizing commitment to quality of service
• Willingness to aid coworkers as needed
• Can help maintain unit morale by encouraging teamwork
CERTIFICATES, LICENSES, REGISTRATIONS
Must have and maintain in good standing professional license, certificate, or registration, as applicable.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.
COMMENTS
This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE:

• Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
• By supplying your phone number, you agree to receive communication via phone or text.
• By submitting your application, you are confirming that you are legally authorized to work in the United States.

Graham Healthcare Group is an Equal Opportunity Employer