Commonwealth Care Alliance
Quality Assurance Reviewer Associate I (Remote)
This job is now closed
Job Description
- Req#: 5001040554906
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Competitive salary
- Opportunity for career advancement and growth within the organization
- Remote work option available
- Supportive and collaborative work environment
- Chance to make a positive impact on healthcare quality and compliance
What to Expect (Job Responsibilities):
- Conduct quality reviews of medical claims and Call Center activities
- Review issuance of ID Cards and Welcome Kits for accuracy
- Verify Enrollment entries for accuracy
- Monitor verbal and written communications of Call Center staff
- Conduct reviews of health care claims and document findings
What is Required (Qualifications):
- Bachelor's Degree or equivalent experience
- 3+ years’ experience in healthcare claims payor, enrollment, or Call Center
- Knowledge of healthcare quality assurance processes
- Strong Microsoft Office skills, particularly in Excel
- Exceptional oral and written communication skills
How to Stand Out (Preferred Qualifications):
- Experience with coaching for performance improvement
- Knowledge of Market Prominence and Medicare plans
- Understanding of CPT, ICD10, HCPCS coding structures
- Strong project management skills
- Ability to handle multiple projects simultaneously
#HealthcareServices #QualityAssurance #RemoteWork #CareerGrowth #Compliance
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Based in Massachusetts, Commonwealth Care Alliance (CCA) is a not-for-profit, community-based healthcare organization dedicated to improving care for individuals who are dually eligible for MassHealth (Medicaid) and Medicare with complex medical, behavioral health and social needs, including persons with disabilities. CCA offers two health plans: Senior Care Options (HMO SNP), for individuals ages 65 and over who have Medicare and MassHealth Standard or only MassHealth Standard; and One Care, a Massachusetts demonstration program for dual eligible individuals ages 21 to 64. These comprehensive health plans provide all the services covered under Medicare and MassHealth, and other benefits as determined necessary by an inter-professional care team in conjunction with CCA’s preferred provider network. For four consecutive years, CCA’s One Care plan received a top consumer rating for quality and access in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) national survey of Medicare-Medicaid Plans (2016, 2017, 2018, and 2019), administered by the Centers for Medicare & Medicaid (CMS).
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