What are the responsibilities and job description for the Quality Control Reviewer I position at 1199SEIU Family of Funds?
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.
Qualifications:
- 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.
