Quality Assurance Specialist (remote in Oregon)

Description

GOBHI has an immediate opening for a full-time Non-Emergent Medical Transportation (NEMT) Quality Assurance Specialist. This remote position will be based out of the employee’s home located in the state of Oregon or accepted radius.

The NEMT Quality Assurance Specialist responds to verbal and written grievances from members and/or providers relating to NEMT. This position has frequent external contact with members, families, and NEMT providers. This position collaborates with internal departments to identify factors necessary for optimal resolution to grievances. This position is also responsible for EDI processes for NEMT claims submission and correction, billing coordination, 405T processes and external and internal reporting.

Essential duties include:

• Establishes and maintains collaborative relationships with community partner agencies and organizations, EOCCO, and NEMT providers to meet NEMT needs.
• Responsible for handling the intake of member grievances through various channels.
• Responsible for generating, reporting, and tracking the status of grievances to ensure resolution and submission deadlines are met.
• Investigates member grievances; talks to members and reviews information in the ride scheduling database.
• Uses conflict resolution and de-escalation skills while talking to members.
• Communicates member grievances to providers; asks for documentation of events leading to grievance.
• Under direction from NEMT Operations Manager and/or NEMT Supervisor, assigns corrective action to providers as needed, per the grievance resolution process.
• Works with NEMT Supervisor on escalated member grievance issues and resolutions.
• Responsible for completing and submitting quarterly EOCCO Grievance & Appeals reports.
• Responsible for preparing and submitting EOCCO NEMT Quarterly Quality Assurance report and monthly FFS report.
• Submits claims (EDI) for each funding source.
• Coordinates with billing specialist and finance to correct claim and NEMT-related invoice issues.
• Corrects denied claims and reports common errors to the NEMT Supervisor.
• Scheduling rides for complicated hospital discharges.
• Coordinates and completes 405T and air transports.
• Negotiates and approves costs for 405T.
• Coordinates payment approval for 405T billing.
• NEMT point person for Essette database.
• Performs other duties as assigned.

Requirements

What is needed to succeed in this role:

• Three years experience in healthcare which have included activities related to managed care or government assistance programs; or any combination of education and experience which would provide the required knowledge and abilities.
• Working understanding of NEMT contract requirements as related to this position.
• Excellent communication skills, both verbal and written.
• Flexible; able to multi-task in response to time-sensitive and changing situations.
• Effective listening skills.
• Objective, solution-focused problem solving skills.
• Handles highly sensitive and confidential information.
• Resourceful, able to network and connect people to appropriate resources.
• Technology savvy, proficient using MS software and Google Suites.
• Strong attention to detail, planning, and organizational skills and follow through.
• Effective presentation skills, including public speaking and meeting facilitation.
• Resilient, stays positive and solution-focused.
• Ability to escalate issues to the NEMT Operations Manager as needed.
• Education – High School diploma or equivalent, Bachelor’s degree in healthcare administration or related field preferred.

What we offer:

• Competitive salary – $60,000 – $65,000 DOE
• Additional compensation for proven bilingual skills in Spanish
• Medical, dental and vision insurance for you and dependents
• 22 paid time off days and 12 paid holidays
• EAP
• FSA, with a $500 employer contribution
• Triple AAA insurance
• Mileage reimbursement
• Wellness benefits
• 401k contribution, including 6.5% employer contributions
• Cell phone and internet reimbursements

About GOBHI:

Founded in 1994, Greater Oregon Behavioral Health, Inc. is an innovative behavioral health organization that serves communities across Oregon. GOBHI is a 501(c)(3) nonprofit corporation that is charged with administering the behavioral health Medicaid benefit, non-emergent medical transportation and community engagement in 12 rural and frontier counties in Oregon.

GOBHI is a co-owner of the Eastern Oregon Coordinated Care Organization, along with Moda Health, and also provides various direct services statewide. GOBHI is committed to better health, better care, and lower costs. Please visit www.gobhi.org to learn more about our mission and services.