Transitions Assistant, TOC-Northern New Jersey

Responsibilities

• Audits clinical records for gaps in quality care metrics and follows a corrective plan with guidance from TOC Navigator to facilitate collections and reporting of required quality metrics.
• Affords support to workflow design that promotes compliance to TOC standards and clinical quality metrics.
• Provides weekly reports to TOC Navigator to assist with quality metrics performance that will maximize metrics compliance.
• Works with providers, care coordinators, and hospital staff to ensure safe patient transitions.
• Afford responsibility for preventative care metric documentation.
• Contacts TOC patients to make appointments for outstanding provider follow-ups, transportation, and discharge phone calls under the direction of the TOC Navigator.
• Performs both inpatient and outpatient audits for Managed Medicaid HMO payers.
• Communicates gaps in quality metrics to Regional Manager and TOC Navigator on a weekly basis.
• Affords assistance to practices in scheduling appointments and referrals which improves accessibility of office services and patient satisfaction.
• In addition to the timely transmission of Electronic Health Records to the next level of care provider.
• Travel to other assigned HMH hospitals to ensure compliance with TOC policies, procedures, and initiatives as directed by the Regional Manager.
• Works with management and TOC Navigator to utilize EPIC software to create and report on TOC outcome measures such as ER, inpatient, and outpatient quality metric results.
• Audit medical records to ensure documentation conforms to TOC standards for inclusion and exclusionary clinical guidelines.
• Identifies the needs of the patient population served and modifies and delivers care that is specific to those needs (i.e., age, culture, language, hearing and/or visually impaired, etc.).
• Communicates with the patient, parent, and/or primary caregiver(s) at their level (developmental/age, educational, literacy, etc.).
• Adheres to the standards identified in the Medical Center's Organizational Competencies.

  Qualifications

  • Associate’s degree or relevant years in healthcare, medical insurance billing, auditing, or related field.
  • Excellent analytical skills.
  • Good reasoning and problem-solving ability.
  • Highly developed interpersonal skills.
  • Proficient at multitasking and prioritization.
  • Ability to work independently as well as in a team environment.
  • Highly organized.
  • Good presentation skills.
  • Demonstrated proficiency with PC and Google Docs skills.
  • Ability to learn and become proficient in electronic medical records and software applications.
  • Registry skills.
  • Experience with auditing commercial medical insurance payers.
  • Bilingual preferred.
  • Experience in a variety of patient settings.