Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
The Senior Administrative Quality Coordinator is responsible for monitoring and reporting compliance issues for the internal delegated functions of Medical Management requirements. This role works with other Medical Management Quality staff and meets stringent turnaround times. Will assist with quality monitoring to ensure Medical Management Performance Coordinator performance is adherent to CMS and NCQA requirements, efficient, and effective in achieving performance goals. Monitoring includes ongoing internal performance audits with improvement actions and overall feedback on the process to ensure that delegation requirements pertaining to NCQA and CMS are met. Provides support to Medical Management staff members, collaborating to promote standard work processes, orchestrates collaboration of team efforts and works to ensure accountability for time and productivity to meet daily quota expectations. Position will be responsible for meeting both turnaround times and quota of case reviews.
- Conducts review of Medical Management cases to ensure accuracy and compliance with CMS and NCQA requirements
- Uses audit tools to perform documentation audits within Medical Management including, but not limited to:
- Implements, tracks and analyzes audits on individual staff to monitor accuracy and integrity of compliance
- Performs regular audits to ensure data entry accuracy
- Performs regular audits to ensure compliance with required documentation
- Identify and communicate with appropriate team members on audit results and/or deficiencies
- Communicates regular audit results and trends to management and interfaces with managers, staff and training to make recommendations on potential training needs or revision in daily operations
- Prepares and presents cases for audits
- Uses internal system tracking tools for review of cases within established turnaround times
- Reports on departmental functions to include, data entry accuracy and monthly trends of audits including, but not limited to:
- Prepares monthly and/ or quarterly summary report compiling data
- Prepares monthly and/ or quarterly detailed and trending employee report
- Participates in the development, planning, and execution of auditing processes
- Foster open communication with managers/directors
- Identify and communicate with appropriate departments, teams, and key leadership on audit results and/or deficiencies
- Identify and communicate findings of case audits compliance with CMS and NCQA requirements to individuals audited and key leadership
- Manages and performs tasks related to audits from contracted health plans as well as pre-delegation review with potential health plans
- Participates in delegation audits and assists business with supplying information as needed
- Notifies appropriate personnel to make any needed corrections in errors
- Prepares reports including those that require manual entry
- Validates accuracy of reports prior to submission
- Submits reports timely according to health plan requirements
- Updates resource training materials and work plans within assigned duties
- Performs user acceptance testing for required regulatory letters and communications, reporting areas out of compliance to relevant team members
- Provides feedback and education to staff
- Performs all other related duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- High School diploma or GED
- 3+ years of experience in managed care, with auditing experience
- Experience with SharePoint, TruCare, MCG and MS Project software
- Sound knowledge of medical terminology
- Proficient software computer skills (Microsoft Excel, including pivot tables and formulas)
- Proficiency with Microsoft Office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
- Undergraduate degree
- Health Plan or MSO quality, audit or compliance experience
- Related experience in healthcare
- Auditing, training or leadership experience
- Clinical data abstraction experience
- Familiarity with ICD-10 coding
- Excellent verbal and written skills
- Demonstrated leadership/mentoring potential
- Adaptable to change
- Good business acumen, especially as it relates to Medicare and Medicaid
- Possess planning, organizing, conflict resolution, negotiation and interpersonal skills
- Independent problem identification/resolution and decision making skills
- Ability to interact with individuals and with multidisciplinary teams
- Ability to demonstrate excellent customer service with internal customers with health plan request
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
Colorado Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Senior Administrative Coordinator, Admin, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote