RN- QA/ Administrative
The RN - QA/Administrative incumbent is a key member of the office staff that provides support to allow for efficient operation of both clinical and financial functions. Acts as a clinical resource for Quality Assurance matters related to documentation standards, insurance authorizations and reimbursement. This RN provides coveraghe in the Cambridge/Mass Pike area, also including Brighton, Alston, Somerville, Medford and Revere.
· Coordinate and communicate patient referral and intake processes.
· .Responsible for the insurance verification and authorization process including timely and accurate processing of eligibility verification for initial and continuing episodes of care and entry of related data into the software system
· Maintain efficient tracking of all pending authorizations to ensure timely provision of care and avoid loss of revenue
· Assist in maintaining standardized operational processes to ensure compliance with company policies, legal requirements, and regulatory mandates
· Maintain absolute confidentiality of all information pertaining to employees, clients and client’s family members.
· Review client charts for completeness and accuracy of documentation ensuring compliance with state, federal, and insurance guidelines.
· Participate in quality assessment performance improvement committees
· Maintain positive relationships with all clients and referral sources.
· Assist the Administrator/Director of Nursing with tasks as assigned (may include direct patient care)
· Perform other functions as deemed appropriate by the management team.
· Current Massachusetts RN license required. Two years of experience in an office setting, preferably in health or home care or medical/dental office.
· Demonstrated proficiency with Microsoft Office (Word, Excel and Outlook) applications, scheduling systems and other health care industry related software.
· Ability to listen and communicate clearly, fluently and diplomatically orally and in writing.
· Ability to remain flexible, resilient, calm and maintain a sense of humor; and present a well-groomed professional image.
· Ability to plan, organize, prioritize delegate and accurately follow through in work activities with time constraints and interruptions to meet deadlines, as well as work independently with a minimum amount of direction and/or supervision.
· Ability to generate goodwill for the Agency with clients, their family members and referral sources. Demonstrate a strong commitment to client service excellence.
Job Type: Full-time
· Medical/Dental office: 2 years