Quality Operations Coordinator

This is a fully remote position, open to applicants in California.

📋 Description

• Provide support and services to PACE market operations through the review of records.

• Gather data and evaluate participant electronic health records utilizing quality-improvement tools.

• Complete reporting and verify all required regulatory elements.

• Detect documentation gaps, trends, deficiencies, and root causes.

• Work collaboratively with clinical and operational teams to enhance processes and ensure regulatory compliance.

• Recognize potential deficiencies and facilitate as well as monitor corrections to maintain the integrity of EHR data.

• Oversee participant medical records to ensure documentation is both complete and timely.

• Report any violations of policies and procedures to the Quality Operations Supervisor.

• Engage in team documentation efforts, process enhancements, and Quality Operations team initiatives.

• Conduct audits of medical records to ensure timely and accurate documentation as required.

• Prepare necessary documents and universe lists for audit desk-review submissions.

• Assist with EMR navigation and impact assessments.

• Review and reconcile assigned regulatory logs.

• Accurately and promptly complete necessary tasks, investigations, and notifications.

⛳️ Requirements

• An Associate’s degree is preferred; three years of experience may be considered in place of education.

• A minimum of two (2) years of work experience in a healthcare setting or related fields.

• Understanding of healthcare quality standards, auditing, regulatory requirements, documentation, and maintaining operational controls in a regulated setting.

• Experience dealing with grievances, complaints, appeals, or member/provider issues within a healthcare, health plan, managed care, PACE, or other regulated environments is highly preferred.

• Bilingual capabilities are an advantage.

• Capability to handle multiple tasks in a demanding environment.

• Strong communication, listening, and organizational skills.

• Extensive experience with the MS Office suite; intermediate to advanced proficiency is preferred.

• Proof of vaccination or a declination form is required prior to employment.

🏝️ Benefits

• Coverage for medical insurance (Medical, Dental, Vision).

• 17 days of personal time off (PTO).

• 12 holidays observed each year.

• 6 sick days.

• 401K savings plan with matching contributions.

• Comprehensive compensation package that includes base salary and bonuses.

• Additional benefits available.

• COVID-19 vaccination policy and infection control/PPE standards in place.