Transitions Assistant, Transitions of Care-Northern NJ

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.
• Accounts 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 support to the Women’s Service team at the network as needed.

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.