What are the responsibilities and job description for the Quality Control Reviewer I position at 1199SEIU Benefit and Pension Funds?
Requisition #:
7151
# of openings:
1
Employment Type
Full time
Position Status
Permanent
Category
Bargaining
Workplace Arrangement
Hybrid
Fund
1199SEIU National Benefit Fund
Job Classification
Non-Exempt
Responsibilities
7151
# of openings:
1
Employment Type
Full time
Position Status
Permanent
Category
Bargaining
Workplace Arrangement
Hybrid
Fund
1199SEIU National Benefit Fund
Job Classification
Non-Exempt
Responsibilities
- Conduct audits associated with provider’s data into different systems (QNXT Medical, Trinity ll (Cactus), spreadsheets, and departmental DMS provider applications).
- Ensuring provider updates related to Delegated Credentialing are reviewed and updated. This includes updating and auditing provider records in provider systems and delegated submissions.
- Respond to and resolve internal and external complex inquires submitted through various methods of communication.
- Data enter accurate provider information into provider systems (provider applications, correspondence, claims, spreadsheets, call tracking issues) as well as identify discrepancies that prevent data from being entered.
- Verify provider participation using on demand reports prior to updating provider file.
- Provide assistance to staff and respond to staff inquires associated with workflows and special projects.
- Track and audit incoming inquiries and distribute inquiries to staff for processing.
- Track and audit completed assignments and return completed inquires to the appropriate areas.
- Execute on demand and scheduled reports. Modify and sort provider information prior to distributing reports to staff for processing.
- Perform special reviews as needed.
- Assist in departmental training/re-training or side-by-side mentoring of staff on new and revised workflows.
- Perform other duties and assignments as directed by management.
- High School Diploma or GED required; some college or degree preferred; plus.
- Minimum two (2) years’ experience as a provider representative in provider systems or provider service environment.
- Excellent keyboarding skills required.
- Knowledge of Medical, Hospital, provider systems (i.e. QNXT Medical, Trinity ll (Cactus), DMS Applications,) preferred.
- Intermediate knowledge of Microsoft Word and Excel preferred.
- Demonstrate proficient navigation skills of web-based applications.
- Excellent oral and written communication skills
- Strong ability to lead, mentor and motivate others, professional manner and presentation.
- Good organizational, problem solver and analytical skills
- Ability to work independently and be a team player.
- Must meet performance standards including attendance and punctuality.
