Claim Angel Jobs (NOW HIRING)

Reports to: Chief Quality & Compliance Officer

Pay Range: $20.00-$21.00

Summary: As the largest pediatric clinic in Jacksonville, serving 11 locations with nearly 45,000 patients, Angel Kids Pediatrics believes that caring for children is a continual process, and should not limited to just doctor office visits during regular business hours. We believe that by providing excellent medical care in a family and community-based environment that we can grow healthy children who will become healthy adults. We uphold the highest standards of a patient-centered medical home that provides quality, personalized and effective medical care as if each family was part of our own

Equity, innovation, and inclusion guide our growth and strategy. We are looking for individuals who are passionate about, and committed to leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive team environment.

Angel Kids is seeking a full-time Quality Improvement Specialist, to join our team located at our corporate office in Jacksonville.

• Coordinate monthly meetings with managed care companies and work directly with managed care companies.
• Analyze various monthly reports and identify quality improvement needs.
• Run reports through Office Practicum and compare to insurance reports provided.
• Conduct chart reviews and claim corrections (if needed).
• Coordinate appropriate training needs across practice, based upon measured outcomes.
• Create, document, and implement policies and procedures (as appropriate).
• Conduct various training sessions (individually and collectively) for new quality improvement initiatives.
• Identify research, gather and analyze data from multiple internal and external sources in order to compare, contrast and synthesize information.
• Assists with identifying statistically significant patterns and trends.
• Prepares and presents reports and recommendations for the QI team.
• Closing care gaps and reconciliation of HEDIS measures.
• Assume leadership in identifying, assessing and refining tools, systems, databases and data elements needed for completing thorough analysis of clinical and claims data.
• Monitor and inforce no show and discharge polices for all patients
• Track reoccurring or unnecessary utilization of the emergency department and coordinate follow up care/education for all patients.
• Monitor and report all coordination of care for patients with chronic conditions practicewide.
Competencies
• AnalyticalSynthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
• Problem SolvingIdentifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
• Planning/OrganizingPrioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
• Quality ManagementLooks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
• TeamworkBalances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
• EthicsTreats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• Interpersonal SkillsFocuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Oral CommunicationSpeaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written CommunicationWrites clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• AdaptabilityAdapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Attendance/PunctualityIs consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
• DependabilityFollows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
Required Education and Experience
• Bachelor's degree from an Accredited College/University or Equivalent experience in health care or public health setting
• Proficient in all Microsoft applications
Preferred Education and Experience
• Bachelor's degree in Public Health from an Accredited College/University and 2 years' related experience or training, or equivalent combination of education and experience.
Equal Employment Opportunity

It is the policy of AKP to provide equal employment opportunity to all employees and applicants for employment and not to discriminate on any basis prohibited by law, including race, color, sex, age, religion, ancestry, national origin, marital status, veteran status, or other legally protected group status. It is our intent and desire that equal employment opportunities will be provided in employment, recruitment, selection compensation, benefits, promotion, demotion, layoff, termination and all other terms and conditions of employment. AKP is committed to this policy and its enforcement

Work Environment

This job operates in a professional medical office environment. This job also operates in a fast paced, highly customer service environment, working with Children and Family/ Guardians. This role routinely uses standard office equipment such as laptop computers and smartphones as well as medical equipment.

Physical Demands

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are Monday through Friday, 8 a.m. to 5p.m. or 9am to 6pm. This position rarely requires long hours and weekend work.