[Remote] Administrative Assistant Representative

Note: The job is a remote job and is open to candidates in USA. Tailored Management is seeking an Administrative Assistant Representative to support the Quality of Care team activities. The role involves managing quality of care cases, communicating with providers, and assisting nurses with documentation and record management.

Responsibilities

• Utilizing QNXT to ascertain if a provider is par vs. non-par
• Communicating with the Grievance Administration Division (GAD) team to clarify complaints or obtain additional information
• Posting cases to the QOC spreadsheet on the T: drive
• Assigning cases to the QOC nurses (once Triaged) in MHK Portlet – equitably according to work flow
• Creating case files on the T: drive
• Requesting medical records (up to 3 requests) and posting received records to case files
• Assisting QOC nurses with completion of QOC resolution letters and mailing of resolution letters
• Maintaining all QOC letter templates and job aids for the QOC team
• Interfacing with providers and facilities in obtaining medical records
• Utilizing CCMS to obtain QOC case information
• Provide weekly and monthly reports on QOC case referrals and CM assigned cases
• Strong attention to detail and work accuracy
• Maintain QOC email box for distribution of emails as appropriate, internal referral cases and collaboration with business partner on the exchange of information pertaining to case reviews
• Manage Conduent fax portlet for incoming faxes to QOC Department
• Note take during Departmental meeting and distributing minutes as appropriate
• Maintain QOC Nurse work sheet and update as appropriate to align with changes
• Assists in the preparation, management and presentation of other Quality of Care reports as appropriate
• Maintains performance against established targets
• Performs other job-related duties as required

Skills

• Three plus years of quality review and improvement experience required
• Two plus years of relevant experience within Quality Management and/or Grievance processes
• Strong attention to detail and work accuracy
• Strong knowledge of common patient disease processes and usual methods of treating them
• Thorough knowledge of medical terminology and commonly used equipment
• Ability to effectively evaluate medical records for appropriateness of care
• Ability to assess and judge the clinical performance of physicians and other health professionals
• Strong analytical, assessment and problem-solving skills
• Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels both inside and outside the organization
• Facilitates an atmosphere of collaboration and team work
• Ability to effectively manage both clinical and non-clinical staff in support of both individual staff and team success
• Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards
• Intermediate skills in Word, PowerPoint, Excel, and Outlook with basic ability to enter data into and navigate through a database
• Maintains confidentiality of all sensitive documents, records, discussions and other information generated in connection with quality of care activities
• Self-directed and able to work independently. Uses appropriate judgment to seek assistance and ask questions
• Keeps QOC Manager updated on overall activities, issues identified, and actions to address issues
• Operates with target dates and deadlines and is able to meet deadlines with successful outcomes
• Appropriately negotiates changes to target dates and holds staff accountable to target dates
• Experience with CMS, NCQA standards, HEDIS, CAHPS, HOS and quality management preferred
• Knowledge/experience in the Medicare/Medicaid industry preferred

Benefits

• Health, Dental, Vision

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