Transitions Assistant, TOC-Southern New Jersey

About the role

The Transitions of Care Assistance Assistant works closely with the Regional Manager, Transitions of Care (TOC) Navigator, physicians, and staff to coordinate and communicate gaps in quality care metrics for all TOC patients. This role assists with patient navigation and preventative screening compliance, audits clinical data, and promotes workflows that support quality patient care and compliance with documentation and clinical outcome metrics. The TOC Assistant communicates with the healthcare team to assist patients in transitions of care across the healthcare continuum and is accountable, along with the TOC Navigator, for meeting clinical quality guidelines and facilitating high-quality, safe patient care. This position is based in the Southern New Jersey Region (Monmouth and Ocean County).

Responsibilities

• Audits clinical records for gaps in quality care metrics and follows a corrective plan with guidance from the TOC Navigator to facilitate collections and reporting of required quality metrics.
• Assists in workflow design that promotes compliance with TOC standards and clinical quality metrics.
• Provides weekly reports to the TOC Navigator to assist with quality metrics performance and maximize compliance.
• Works with providers, care coordinators, and hospital staff to ensure safe patient transitions.
• Accountable for preventative care metric documentation.
• Contacts TOC patients to schedule 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 the Regional Manager and TOC Navigator on a weekly basis.
• Assists practices in scheduling appointments and referrals to improve accessibility of office services and patient satisfaction, including timely transmission of Electronic Health Records to the next level of care provider.
• Travels to other assigned HMH hospitals to ensure compliance with TOC policies, procedures, and initiatives as directed by the Regional Manager.
• Works with management and the TOC Navigator to utilize EPIC software to create and report on TOC outcome measures such as ER, inpatient, and outpatient quality metric results.
• Audits 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 specific to those needs (e.g., age, culture, language, hearing and/or visually impaired). This includes communicating with the patient, parent, and/or primary caregiver at their level (developmental/age, educational, literacy).
• Adheres to the standards identified in the Medical Center's Organizational Competencies.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Associate’s degree or relevant years in healthcare, medical insurance billing, auditing, or a 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.
• Ability to learn and become proficient in electronic medical records and software applications.

Education, Knowledge, Skills and Abilities Preferred:

• Registry skills.
• Experience with auditing commercial medical insurance payers.
• Bilingual preferred.
• Experience in a variety of patient settings.

Pay

Minimum starting rate of $24.34 per hour. The posted rate of pay is a reasonable good-faith estimate of the minimum base pay for this role at the time of posting and does not reflect the full value of our market-competitive total rewards package. The base compensation determined at the time of the offer may differ based on factors including labor market data, experience, education, certifications, skills, geographic location, internal equity, budget, and grant funding.

Benefits

HMH offers a comprehensive benefits package for full-time and part-time (20+ hours/week) job positions, including:

• Health, dental, and vision coverage.
• Paid leave.
• Tuition reimbursement.
• Retirement benefits.

Certain positions may also be eligible for performance-based incentives, bonuses, commissions, or shift differentials for work performed on evening, night, or weekend shifts.