Quality Improvement Associate

Job Overview
We are seeking a proactive and detail-oriented Quality Improvement Associate to join our healthcare compliance team. This position provides support for the overall Quality Improvement Program under the direction of the QI/Risk Manager.

Roles & Responsibilities

· Maintains commercial and CMO insurance rosters and remains familiar with measures required to satisfy quality programs

· Access patient portal to determine the patients whom were discharged from the hospital and are in need of a hospital follow-up appointment.

· Work closely with the Care Coordinators to contact the patient to get the hospital follow-up appointment scheduled.

· Assisting to close care gaps by uploading the proof of the result and/or test to the patients chart.

· Responsible for reviewing The Patient Care Opportunity Report (PCOR) for appropriate member attribution. A monthly spreadsheet is kept and emailed at the end of the month to Linda Godwin.

· Assist in making outreach calls to patients as needed.

· Constant reviewing and consistent communication with insurance payors (CMO’s and commercial payors) regarding open care opportunities such as (Colorectal Screenings, Mammograms, Retinal Screenings, A1C, Blood Pressure, Nephropathy etc…)

· Responsible for the review of patients for Annual Wellness Visit opportunities and scheduling those patients for the service.

· Accounts are reviewed and patients are scheduled for Retinal Screenings in accordance to the Retinal Camera schedule.

· Protects patients’ rights by maintaining confidentiality of personal and financial information.

· Maintains Appointment Scheduling Template on EClinical; reviews in advance for accuracy. Responsible for scanning demographic information in a timely manner.

· Assists with answering phones focusing on customer service; takes thorough message or forwards to appropriate staff

· Protects patients’ rights by maintaining confidentiality of personal and financial information.

· Schedules follow-up appointment making sure that visit type matches diagnosis

· Calls No-Show patients to reschedule appointment.

· Maintains Appointment Scheduling Template on EClinical; reviews in advance for accuracy. Responsible for scanning demographic information in a timely manner.

· Assists with answering phones focusing on customer service; takes thorough message or forwards to appropriate staff

· Schedule patient transportation as needed. Maintain transportation log.

· Other duties as assigned

Qualifications & Education Requirements

· High School diploma or GED required. At least two years medical practice and / or billing experience required. Relevant education may substitute experience requirement.

Knowledge, Skills, & Abilities

· Communicates clearly and concisely, verbally and in writing

· Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations

· Able to work effectively with other employees, patients, and external parties

· Demonstrates proficiency in PC applications as required

· Demonstrates knowledge and understanding of organizational policies, procedures and systems

· Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly.

Organizational Values

· PCSG is a values-based organization. All our decisions, actions and conduct are guided by our core values:

o Compassion: We believe in acting with empathy and understanding, valuing the well-being of our colleagues, patients, and community.

o Integrity: We uphold the highest standards of honesty and ethical conduct.

o Teamwork: We foster a collaborative environment where everyone's contributions are valued.

o Accountability: We take responsibility for our actions and their outcomes.

o Respect: We treat everyone with dignity and consideration.

Physical Demands

· Requires sitting for prolonged periods of time. Occasionally lifts and carries items weighing up to 20 lbs. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to communicate effectively with the Public.

Working Conditions

· Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Requires lifting papers or boxes up to 50 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people.

Benefits:

• AD&D insurance
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person