Healthcare Administrative Assistant - Medical Review/Program Integrity Coordinator
- Job Title
- Healthcare Administrative Assistant - Medical Review/Program Integrity Coordinator
- Job ID
- 27731465
- Work Hybrid
- Yes
- Location
- Dallas, TX
- Other Location
- Description
-
Healthcare Administrative Assistant - Medical Review/Program Integrity Coordinator
Dallas, TX
(Hybrid schedule with 2 days onsite)
@Orchard LLC is retained by a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our Client is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.
Our client is seeking a Healthcare Administrative Assistant (MR/PI Coordinator) for their Dallas, TX office. If you have strong administrative/clerical skills, medical claims, medical records, or healthcare experience, and/or knowledge of Medicare/Medicaid, this could be the job for you! This is an office based, hourly administrative/clerical position, offering a hybrid schedule of 2 days onsite/3 days remote.
This position supports a Unified Program Integrity Contractors team for the Southwestern Jurisdiction (UPIC Southwest),and offers the opportunity to contribute to their efforts to make a positive difference in the future of our nation's healthcare programs. The UPIC Southwest team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering 7 states.
Essential Duties and Responsibilities:- Works with other CMS contractors to implement, revise and remove claims system edits.
- Work within the Medicare claims processing systems to monitor the status of UPIC initiated edits.
- Responsible for sending out correspondence, such as: educational letters, prepay notification letters, suspension correspondence.
- Responsible for monitoring and creating reports that show the results of system edits and present these findings at the Prepay Committee Meetings.
- Attend the UPIC Sample and Medical Review meetings.
- Initiates and maintains communication with the UPIC legal team, RFI Coordinator, and law Enforcement to manage the transfer of case/investigation information.
- Work closely with the UPIC legal team in response to FOIAs, RFIs, ALJ Hearings, Congressional Complaints, and other related activities.
- Responsible for tracking and creating reports related to the results of upper level appeals.
- Responds to client inquiries via written or oral communications.
- Work within internal and external tracking systems to monitor the status of payment suspensions, zone restrictions, and other cases or investigations as assigned.
- Responsible for monitoring and creating reports that indicate monitoring of identified administrative actions.
- Attend the UPIC Sample and Medical Review meetings and update tracking systems with information from the meeting.
- Work with the Lead MR nurses to compile and send out overpayment packets to the Medicare Administrative Contractors and providers.
- Coordinate and manage the transition of workloads, and serve as the interface with other entities.
- Creates reports on a monthly and ad hoc basis
- Provides training and technical advice to team members.
- Works with Quality Director/Officer on ISO initiatives to improve operational systems, processes and policies to improve information flow, management reporting, business process and organizational planning.
- Participates and/or leads internal/external committees as assigned.
Education and/or Experience Required:- High school diploma or GED required, Associates Degree in business preferred;
- At least 1 year experience in an administrative position; or an equivalent combination of education and experience.
- Self-driven with the ability to take ownership and look for solutions.
- Experience working with data entry and databases.
- Prior experience with medical claims processing a plus.
- Prior experience working with medical records a plus.
- General understanding of Medicare and Medicaid a plus.
- Prior experience working on government contracts preferred.
- Working knowledge of Medicare and/or Medicaid protocols for Fraud and Abuse investigations preferred.
- Intermediate level Microsoft Office (Word, Excel and Outlook) skills and proficiency in the use of database software and PDF files.
Established in 2010, @Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atorchard.com.