Provider Review Services Jobs
Apply Now - Provider Review Services Coordinator
Overview
This position focuses on managing tasks for provider review services with a primary emphasis in data management and transformation. The Provider Review Services Coordinator will assist with planning, preparing, overseeing and finalizing provider review projects in an efficient and timely manner.
* This is a remote/work from home position *
Responsibilities
- Substantial experience with ETL data transformation (extract, transform and load data, while ensuring its integrity)
- Experience with use of transformation tools such as OpenRefine, ASAP Utilities or Microsoft SQL
- Advanced Microsoft Excel skills (using functions and formulas, pivottables, analyzing data, etc.)
- Proficiency with additional Microsoft applications, especially Teams and OneNote
- ICD-10-CM, E&M, and CPT knowledge base preferred
- Demonstrates strong communication skills, both orally and written
- High level of interpersonal skills to handle sensitive/confidential situations and documentation
- Must be detail-oriented, organized, able to prioritize tasks and consistently meet deadlines
- Independent, focused individual with established work ethic
- High Speed Internet accessibility via Cable (no Satellite or wireless cell based)
Job Summary
Review Projects
- Assists with review prep calls, taking notes of client objectives for each audit
- Creates project in audit database (Particle) and associated folders on secure portal (Nucleus)
- Schedules review kickoff call with client and project lead
- Manages contact list in Particle and assigns roles for access to secure portal
- Creates/manages Microsoft Team and OneNote Notebooks for each client and updates with new policies as well as project-specific details
Pull Lists – Provider Reviews
- Checks files for accuracy of content, codes, and missing information upon receipt; runs pivot tables
- Formats data as necessary to obtain sample (uses available data transformation utilities)
- Selects sample based on client parameters (focused, random, by coder, by provider, etc.)
- Loads data into template and imports into audit database
Large Client Projects / Interim Projects
- Tracks progress in spreadsheets for HIA and client weekly status updates
- Prepares and imports pull lists for monthly interim projects
- Assists with importing rebuttals and notifications to team lead
- May assist with running customized reports
Additional Tasks
- Runs Outstanding Tracking Report and sends to consultants for project completion or closeout
- Assists with chart replacements during current projects (wrong patient type, combined accounts)
- Creates monthly interim projects in audit database
- Prepares and distributes client reports—as requested by manager
- Assists with scheduling internal HIA Reviewer QA reviews and importing chart samples
- Downloads files from secure portal to SharePoint as needed (scanned record projects)
- Monitors remote access by consultant and facility and works with IT to follow up on outstanding access
