Summary:
This role promotes and supports quality of services within the organization, by completing key administrative tasks related to New Narrative clinical, residential, and peer operations. The Quality and Impact Generalist works collaboratively with all staff to ensure high quality data entry, records management, and reviews to meet participant, auditor, contract, and staff requests. The position will help evaluate participant satisfaction and support compliance and coordinate with managers and leadership team members around ad hoc projects as needed.
Essential Duties and Responsibilities:
Program Participant Focus
· Coordinates with agency-wide program participants in reviewing PHI requests, obtaining necessary documentation, advocacy amongst grievances and consumer feedback, and other projects, as necessary
· Assistance in a consumer survey planning, administration, data pulls, and analysis
· Conducts chart reviews alongside QI Director to assess for medical necessity, ensure record compliance, and predict training needs
· Supports the Records Specialist with fulfillment of medical records requests and fills records requests in accordance with deadlines for audits, licensure, appeals, subpoenas, court orders, benefits inquiries, and external investigations
Clinical and Service Focus
· Supports agency credentialing, including tracking clinical credentials for all staff, individual and agency provider enrollment & reporting to payers, maintaining active credentials in EHR, auditing individual staff credential status, and answering staff inquiries regarding credentialing as well as any ad hoc credentialing needs as identified by QI Director Human Resources, Billing, or Finance
· Assists Health Systems Administrator and Medical Department with pending invoices, sending results to clinical and pharmacy staff, and other care coordination needs associated with Kashi Labs and other lab partners.
· Support the Records Specialist, Intake Specialist and Clinical Teams as needed to send/receive information from new participants consent documentation through DocuSign, email, or USPS
· Support Medical Department with prior authorization needs
· Assists as needed in investigations regarding critical incidents, grievances/complaints, APS cases, appeals, etc.
· Assist teams in chart compliance by uploading scanned documents and attachments from residential teams
· Participates in planning agenda and completing minutes as necessary for monthly and quarterly QI meetings
Database Support
· Ensures data transfer of identified documents from legacy electronic health record to Credible
· Navigates between legacy EHR and Credible as needed to ensure accessibility of documentation, insurance information, required forms, and billing information
· Data entry for content as needed between legacy EHR and Credible
· Support with the maintenance of user profiles and assist end-users as needed
· Directly coordinate as directed with New Narrative Pharmacy staff to support data entry, data transfer, data retrieval between databases
· Uploading and maintenance of external databases and mandated reporting (Collective Medical and MOTS)
· Supports Health Systems Administration, Billing Department, and sole contributors in correcting EHR data errors.
Positions Reporting: None
Core Competencies:
· Communication: Direct, concise, and collaborative. Keeps others informed. Listens effectively to others. Maintains positive and open communications with staff.
· Teamwork: Effective at working in team situations.
· Initiative/Results Oriented: Originates action. Finds ways to get things done.
· Quality: Promotes continuous improvement. Effectively utilizes data.
· Customer Responsiveness: Responds well to internal and external customer needs.
· Analytical Thinking: Attention to detail over sustained periods of time and ability to analyze data and recognize trends.
· Dependability: Counted on to follow through on commitments; at work each day and on time; work completed in a timely fashion.
· Aptitude: Ability to comprehend and apply new ideas, processes, procedures, or training.
· Organizational Awareness: Understands the culture of the organization; interests and concerns of various groups.
· Sensitive Information: Exposure to highly confidential information. Must maintain the highest level of discretion and organization’s security.
· Motivate: On-going ability to motivate others and remain consistently enthusiastic.
· Demeanor: Remaining calm in crisis situations, empathetic, unbiased, and excellent interpretation skills.
Education/Certificates/Licenses/Registration: QMHA preferred or a minimum of two years providing administrative support within a healthcare environment, including participant engagement experience.
Experience/Qualifications: Applicants with experience working in Credible and experience in HIPAA compliance a plus
