Quality Assurance Specialist, Provider Enrollment

Full Time
Bedford, MA 01730
Posted
Job description

$1,500 SIGNING BONUS

Are you interested in joining a team that strives to positively impact the healthcare system?

LogixHealth provides services and technology that result in smarter healthcare. We need the best and most inspired team members and are looking for people with a high level of intellectual curiosity and drive who always ask "why" and "how can we do it smarter."

If we have piqued your interest and you also possess:

  • A strong attention to detail and active listening skills
  • Proficient computer and Microsoft Excel skills
  • The ability to multitask

We want to meet YOU!

Purpose

Provide first line review of documentation for the completion of internal audits for Bedford representatives and second line of review for LHI representatives. Research and resolve items such as CAQH issues, deactivations and revalidations.

Duties and Responsibilities

  • Assist the Audit Supervisor in the development, training and auditing of all LHI and Bedford reps
  • Become and remain knowledgeable on key business processes and systems and how they integrate with quality enrollments for groups and providers
  • Review and identify feedback opportunities for all representatives in all locations
  • Review new group/provider set-ups for documentation and accuracy and report results to management
  • Analyze trends in audits to assist with the development of LHI education and training
  • Complete various internal single focus audits and provide analysis that identifies trends to determine areas of risk and additional up training
  • Obtain information as requested by management
  • Complete assigned special projects as needed
  • Attend scheduled meetings with supervisor
  • Collaborate with Provider Enrollment Supervisors to establish quality control standards
  • Adhere to the Code of Conduct and be familiar with all compliance policies and procedures stored in LogixGarden relevant to this position

Qualifications

To perform this job successfully, an individual must be able to perform each duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities perform the duties.

Education (Degrees, Certificates, Licenses, Etc.)

College degree preferred. A High School Diploma and equivalent combination of education and experience will be considered

Computer Skills

Prior word processing, spreadsheet and internet software experience including proficiency with MS Excel and MS Word required.

Experience

One to two years related experience preferred.

Specific Job Knowledge, Skill and Ability

  • Ability to add, to subtract, multiply and divide in all units of measure; this ability will encompass using whole numbers, common fractions and decimals
  • Ability to compute rates, ratios and percentages
  • Ability to identify an solve problems
  • Ability to read and interpret documents
  • Ability to write routine reports and correspondence
  • Ability to communicate effectively verbally and in writing to various audiences
  • Ability to apply common sense understanding to carry out instructions furnished in writing or verbally
  • Ability to deal with problems involving several concrete variables in standardized situations
  • Specific vision abilities required by this job include close vision
  • Ability to sit for prolonged periods of time, use hands, talk, hear and occasionally walk and reach with hands or arms.

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