Quality Operations Coordinator

Summary

WelbeHealth is a value-based healthcare organization providing comprehensive care and social services to vulnerable seniors through the PACE model. The Quality Operations Coordinator supports PACE operations by auditing participant medical records, monitoring documentation, ensuring regulatory compliance, and collaborating with care teams on quality and process improvement.

Responsibilities

• Identify potential deficiencies, facilitate, and monitor appropriate corrections to ensure data integrity in the EHR. Monitor participant medical records for complete and timely documentation and promptly report to Quality Operations Supervisor when policies and procedures are not being followed
• Participate in team documentation, process improvements and other QO team initiatives
• Conduct medical records audits to ensure all required documentation is timely and accurate
• Assist with WelbeHealth audits by preparing documents for desk review submission (universe lists) as well as assist with EMR navigation and impact analysis
• Review and reconcile assigned regulatory logs
• Complete all required tasks in a timely and accurate manner
• Complete required investigations and notifications

Skills

• May substitute three years' experience in lieu of education
• Minimum two (2) years' work experience in a healthcare setting or related areas
• Familiarity with healthcare quality standards, auditing, regulatory requirements, documentation, and maintaining operational controls in a regulated environment
• Experience working with grievances, complaints, appeals, or member/provider issues within a healthcare, health plan, managed care, PACE, or other regulated healthcare environment
• Ability to multi-task in a challenging environment is necessary
• Excellent communication, listening, and organization skills
• Associate's degree preferred
• Experience working with grievances, complaints, appeals, or member/provider issues within a healthcare, health plan, managed care, PACE, or other regulated healthcare environment is highly desired
• Bilingual is a plus
• Extensive MS office suite experience (Intermediate to advanced level proficiency is desired)

Qualifications

Must Haves

• may substitute three years' experience in lieu of education
• Minimum two (2) years' work experience in a healthcare setting or related areas
• Familiarity with healthcare quality standards, auditing, regulatory requirements, documentation, and maintaining operational controls in a regulated environment
• Experience working with grievances, complaints, appeals, or member/provider issues within a healthcare, health plan, managed care, PACE, or other regulated healthcare environment
• Ability to multi-task in a challenging environment is necessary
• Excellent communication, listening, and organization skills

Nice to Haves

• Associate's degree preferred
• Experience working with grievances, complaints, appeals, or member/provider issues within a healthcare, health plan, managed care, PACE, or other regulated healthcare environment is highly desired
• Bilingual is a plus
• Extensive MS office suite experience (Intermediate to advanced level proficiency is desired)

Benefits

• Medical insurance coverage (Medical, Dental, Vision)
• 17 days of personal time off (PTO)
• 12 holidays observed annually
• 6 sick days
• 401K savings + match
• Bonus as part of the comprehensive compensation package