Job Title: QI STARS Administrative Support I
Duration: 3+ months (Higher Possibility with Extension)
Location: Jacksonville FL
- High school diploma or GED.
- 3 years of related work experience in managed care and direct customer service or equivalent combination of transferrable experience and education.
- Strong computer skills to include Microsoft Office products (Word, Excel, PowerPoint and Outlook) and Internet research skills.
- Strong administrative skills to include: member and provider calls, faxing, ability to request records, communicate clearly, documentation.
- Bachelors degree or equivalent work experience.
- Experience in or working knowledge of Quality Improvement Initiatives, HEDIS, Medicare STARS and Quality Rating Systems.
- Deep understanding of health insurance industry, health care systems, and provider issues.
- Advanced understanding of medical terminology, abbreviations, body systems/anatomy, physiology and concepts of disease processes.
- Perform clerical functions to include; medical record request, faxing and calls to members and providers as needed.
- Maintain organized, updated reporting of activities with clear documentation.
- Complete claim research to identify the service performed, dates of service, provider type, and place of service. Research may include multiple systems and reports.
- Provide support to assess and analyze available information from internal and external data, and other sources as needed
Comments for Suppliers: Top Choice Candidates:
- Extensive experience w/ Administration and Medical Care; familiar with HEDIS measures.
- Medical Assistance Cert.
- Bilingual (English primary, Spanish secondary).
- Temporarily Remote due to COVID - Jacksonville, FL
- Experience with OBC's to Providers and Members
- Experience with Medicare
- Experience with Stars