Quality Assurance Specialist

Peak Vista Community Health Centers is a nonprofit health care organization whose mission is to provide exceptional health care to people facing access barriers through clinical programs and education. We provide integrated health care services to include medical, dental and behavioral health throughout 26 outpatient health centers within El Paso, Teller, Lincoln, Adams, Elbert and Kit Carson counties. We deliver care with our strong Hospitality culture. Our organization has over 950 employees and serves more than 94,000 patients annually in the Pikes Peak and East Central regions of Colorado. Peak Vista is accredited by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC).

Compensation (Pay): $14.06 to $21.01 based on experience.

Summary of Benefits:

• Medical, Dental, Vision, Life, STD, LTD
• 403(b) Retirement with Company Match
• Paid Time Off
• Tuition Assistance
• Perks Rewards
• Employee Assistance Program

https://www.peakvista.org/careers/employee-benefits-guide

Job Summary: Quality Assurance staff will complete eligibility applications with patients, and guide patients through the insurance exchange process. Quality Assurance staff will work with patients to understand how their benefits will be used at Peak Vista, to include out of pocket expectations and patient responsibility. Quality Assurance staff will educate patients on the benefits of secondary coverage. Quality Assurance staff will be responsible for many aspects of patient needs and customer service. Employees provide exceptional care, to internal and external customers, at every interaction. Quality Assurance staff will support Reception functions, across all clinics.

Essential Duties and Responsibilities:

• Determines eligibility for CICP applications, verifying private insurance, CHP+ and Medicaid on Webportal.
• Registers patients who currently have private insurance, Medicaid, and/or CHP+ and ensure all paperwork/eligibility is reviewed with each patient.
• Data Entry into practice management systems.
• Reception duties, as assigned.
• Answers calls regarding patient coverage status, payer contract and billing questions, transferring calls to appropriate departments and other patient service duties.
• Makes appointments for enrollment and clinics.
• Supports many internal departments by providing quality customer service.
• Contributes to a culture of kindness. Adheres to assigned schedules.
• Displays a willingness to learn.
• Adapts to departmental and organizational changes.
• Displays strong detailed oriented skills with the proven ability to multitask.
• Audits and reports, to include all type of applications and processes, and all reception functions.
• Analysis of data sets to identify training needs.
• Promotes and demonstrates the mission, vision, and Core Values of Peak Vista.
• Develops and maintains good working relationships with all departments, the management team, medical staff, and leadership.
• Embraces cultural diversity amongst ourselves and our community.
• Responsible for the human, financial, and material resources as well as data and information entrusted to us.
• Strives to deliver the best outcomes and highest quality service.
• Demonstrates knowledge of and adherence to the Compliance Plan and conflict of interest requirements.
• Enhances the effectiveness, efficiency and productivity of the department by contributing to, and participating in, departmental performance improvement goals.
• Performs other duties as assigned.

Supervision Exercised: None

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Spanish bilingual preferred.

Education/Experience:

Education: High school diploma or equivalent education.

Work Experience: One-year customer service experience in healthcare setting required.

Computer Skills: Basic ability to access the intra/internet to manage timecard, review policies and procedures, and read company communications; use e-mail to communicate with co-workers, leadership, and other departments; enter and correct data, modify a workbook, format a worksheet, and use printing functions; create a simple presentation in PowerPoint, run it, and print it.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must occasionally lift and/or move up to 20 pounds.

*Successful candidates will complete pre-employment screening; which includes but is not limited to, a Criminal Background check. Peak Vista Community Health Centers is a drug and alcohol-free workplace and an Equal Opportunity Employer.

*PVCHC participates in the Electronic Employment Verification Program. E-Verify is an Internet-based system that compares information from an employees I-9 to data from the U.S. Department of Homeland Security and Social Security Administration Records. To learn more, visit: everify.com