About iMPROve Health
Come join the iMPROve Health team! iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization. We are both a Cool Place to Work (Crain’s Detroit Business) for the last 4 years and one of the Best Places to Work in Healthcare as judged by Modern Healthcare. As a nonprofit organization, we have more than 40 years’ experience improving healthcare across the continuum of care using evidence-based and data-driven logic. iMPROve Health provides medical consulting and review, as well as data analysis to federal agencies, state Medicaid and public health organizations, healthcare facilities, private health plans and other third-party payers. We also have extensive experience completing thoughtful and impartial utilization review, dispute resolution and peer reviews. Our goal is simple – to help healthcare get better!
This position is 100% remote and provides the opportunity to work virtually with team members from anywhere within the United States. We pride ourselves on providing a great work/life balance for employees, while also providing the ability to promote their career development and gain new skills through employee education opportunities. iMPROve Health offers a wonderful benefit package that includes medical, dental, vision, life insurance, short term and long-term disability, and a generous 401k match.
iMPROve Health is committed to improving the quality, safety, and efficiency of healthcare. Although we do not see patients, we are healthcare professionals (including physicians and nurses) and consultants who work with healthcare providers to promote the adoption and use of evidence-based best practices and processes to achieve our healthcare quality goals. Our services offer our clients and partners access to a proven, impartial, connected resource that understands the intricacies of healthcare. It is our #1 priority to provide thoughtful evidence-based strategies and solutions that help them achieve their healthcare quality improvement goals and outcomes.
iMPROve Health is an equal employment opportunity employer.
*Must be able to work M-F normal business hours in EST.
SUMMARY:
The Eligibility Coordinator is responsible for all aspects of the eligibility process for the NSA Federal & State IDRE programs, including analysis of all new cases to determine if a case is eligible, ineligible, or requires outreach to determine eligibility. The Eligibility Coordinator assists the team in managing complex disputes and develops and implements eligibility training in collaboration with the Program Managers and Managing Director.
Computer usage is constant and requires knowledge and experience in the application and operation of software programs such as Microsoft Office, all Windows software products, and web-based portals. Work may involve the development of moderately complex spreadsheets, multi-tasking group projects, and assistance with portal development and enhancements. Core competencies include attention to detail, reliability, effective communication, collaboration, accountability, effective time management and problem-solving skills.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Responsible for the successful completion of assigned contract deliverables according to contract requirements.
- Develops, plans, and implements team eligibility training. Understands all aspects of the eligibility process and implements onboarding training and targeted training to address identified gaps.
- Identified and implements strategies to ensure the validity and reliability of eligibility determinations.
- Utilizes time and project management skills to ensure assigned activities are completed in a timely manner and in accordance with contract requirements. Applies problem solving abilities to identify, resolve and/or communicate potential delays or problems in advance of deadlines.
- Accurate and timely data entry into designed CMS system and department database.
- Manage and process all incoming and outgoing IDRE Program Case Reviews as they relate to eligibility.
- Adhere to all security guidelines for safe transmission of case reviews. Process them in a timely, efficient manner
- Works with the NSA Federal & State IDRE team to ensure compliance with all applicable federal and state regulations
- Adheres to all relevant compliance regulations (HIPAA, FISMA, URAC, CMS).
- Maintains up to date knowledge, training and adherence with all compliance and regulatory requirements for contracts, governmental and compliance regulatory organizations.
EDUCATION AND/OR EXPERIENCE:
- Bachelor's degree required in a healthcare specialty. Master’s degree preferred.
- 5 years of project support experience in a corporate/professional environment with a proven record of meeting project deadlines required.
- Relevant knowledge of the Federal No Surprises Act.
- Project management skills required.
- Understanding of quality improvement concepts preferred.
- Strong communication skills, both verbal and written required.
- Strong multi-tasking skills with attention to detail and deadlines required.
COMPUTER SKILLS:
- Proficient in GroupWise or other e-mail program, such as Outlook
- Proficient in Microsoft Word and Excel
- Working knowledge of PowerPoint, Microsoft Access and Visio
