Hospice Quality Assurance Administrator
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Job Description
Hospice Quality Assurance Administrator supporting quality and clinical operations teams at Graham Healthcare Group. Ensuring compliance and collaboration with various departments for hospice care.
Responsibilities:
- Meet quality and productivity standards and deadlines/turnaround times established by Hospice
- Perform daily HCHB workflow maintenance to ensure the 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 the 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 the medical record
- Perform data entry of medications dispensed by the pharmacy and monitor the HCHB interface
- Ensure accurate and timely submission of HIS data and keep current on changing rules and regulations as related to HIS
- Communicate with the various insurance companies to ensure proper processes are being met, and ensure payments are correct
- Assist, when necessary, with planning and scheduling face-to-face visits with Nurse Practitioners and Hospice physicians to maintain compliance
- Perform Quality Assurance audits as directed
Requirements:
- High school diploma or equivalent, some college coursework 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 the HCHB program preferred
- Working knowledge of Medicare Part D plans and prior authorizations
- Knowledgeable in medical terminology, pharmacology, and the insurance pre-authorization process
- Medical Assistant certification preferred
- Understanding of various medical insurance processes
- Ability to read and follow written instructions and document
- 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
Benefits:
- Health, Vision, & Dental
- 401K & Pension w/ 4% employer contribution
- PTO: 15 Days
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