QI STARS Administrative Support I

Integrated Resources, Inc
Published
September 3, 2020
Location
Jacksonville, FL
Category
Job Type

Description

Job Title: QI STARS Administrative Support I

Duration:  3+ months (Higher Possibility with Extension)

Location:  Jacksonville FL

Requirements:

  • 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.

Preferred:

  • 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.

Job Description:

  • 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

Basic Requirements:

  • Experience with OBC's to Providers and Members
  • Experience with Medicare
  • Experience with Stars
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