Job Details

Quality Control Coordinator

This position will be responsible for reviewing the quality of work produced by the referral management and intake teams. Information and materials generated from these departments will be for final review by the Intake Director and Quality Control Coordinator. Including, but not limited to, verification of customer insurance, healthcare claim submissions, PDP and medical prior authorizations, and other related work produced. Direct communication with insurance organizations may be required.

Essential duties and responsibilities include the following. Other duties may be assigned, as necessary.

• Reviews insurance operational areas:
• Insurance Verification and entry into Care Tend
• Prior Authorization completion in CT
• Preparation for Claim Submission
• Intake Workflow
• Copay Assistance / billing
• Insurance software
• Performs a variety of office functions, such as filing, typing, copying, data entry, research, etc., to support various billing and financial operations.
• Nursing Software/Nursing Note Submission & Nurse tracking.
• Billing preparations for nursing notes
• Adheres to confidentiality, safety, compliance, and legal requirements.
• Ongoing Communication with Referral Management, Billing, Insurance Verification, and Data Entry.
• Assists in appropriate product selection by understanding all payers, reimbursement, and formularies.
• Comply with company deadlines and inventory to meet both the company and its compliance standards.
• Consistently represents the company in a professional manner.
• Maintains effective working relationship and cooperates with all personnel in the Company.
• Participate in administrative staff meetings and attend other meetings and seminars.
• Performs other related duties as assigned or requested.

Qualification Requirements:

• Provides the highest level of professionalism, responsiveness, and communication to build and maintain the maximum customer base possible.
• Possesses the ability to multi-task and frequently change direction as required.

Education and/or Experience:

• A High School Diploma or equivalent GED is required, at minimum. College or technical college preferred.
• 3 - 5 years medical experience.
• Ability to work independently and within a multidisciplinary team.
• Minimum two years in healthcare environment/industry.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or listen. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

Notice: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

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CSI Pharmacy is an Equal Opportunity Employer.