Quality Program Specialist

Base Salary Range: $44,537.60 - $71,260.17 Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Position Overview: The Quality Program Specialist will work directly with internal PacificSource Risk Adjustment and Quality teams processing all medical record requests in a timely and efficient manner ensuring accuracy and providing the highest quality medical record. The Quality Program Specialist must always safeguard and protect the patient’s right to privacy by ensuring that only authorized individuals have access to the patient’s medical information and that all releases of information follow the request, authorization, PacificSource Health Plans company policy, and HIPAA regulations. Essential Responsibilities: Receives incoming requests for medical records and responds to request in timely and efficient manner ensuring the correct medical record is obtained and valid for risk adjustment and quality review purposes. Validates requests and authorizations for release of medical information according to established procedures and HIPAA guidelines. Performs quality check on all chart retrieval workbooks to verify accuracy of the records before submission to coding. Ability to work with minimum supervision, organize workload and prioritize work tasks to meet production goals. Communicates with Manager on an on-going basis, providing information and data as requested including retrieval feedback needs and requests. Promptly reports to Manager any customer service concerns and/or any potential HIPAA violations whether actual or perceived. Assist in obtaining and managing remote EHR access for our chart review vendors and internal PacificSource teams. Participate in cross functional teams to support critical quality activities and achieve performance targets. Management of member records including file storage that’s in alignment with HIPAA laws and regulations and in compliance with Business Associate Agreements. Supporting Responsibilities: Represent department, both internally and externally, as required. Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: 2 years of experience in the health insurance or medical industry required or equivalent education/experience. Experience with Medicare preferred. Education, Certificates, Licenses: High school diploma or equivalent required. Associate degree preferred. Knowledge: General knowledge and understanding of medical terminology, ICD-10-CM, CPT, and health insurance. Ability to review, evaluate and present quality medical records and reports. Good organizational skills with experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, and audio-visual equipment. Knowledge/experience with Medicare quality programs (CMS 5-Star, HEDIS, risk adjustment) preferred. Must have strong analytical and problem-solving skills. Ability to effectively communicate with all levels of staff and management. Must be self-motivated, organized, and detail oriented. Ability to work independently with minimal supervision. Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust Continuous Improvement Contributing to Team Success Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time for onsite retrieval processes. Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our 1,900 employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 600,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance October 17: Central Oregon Community College Job Fest, 10a-1p at COCC Coats Campus Center (2600 NW College Way, Bend OR 97703) October 18: Boise State University Career Fair, 10a-2p at Student Union Building (1910 W University Drive , Boise ID 83706) October 18: Oregon State University Healthcare Career Fair, 11a-3p at Career Center (725 Southwest 26th Street, Corvallis OR 97331) October 19: University of Oregon Fall Career Fair, 12-4p at EMU Ballroom (1395 University Street, Eugene OR 97403) October 27: Boise State University Veterans Job Fair, 1-4p at Student Union Building (1910 W University Drive, Boise ID 83706) February 1: University of Oregon Winter Career Fair, 12-4p at EMU Ballroom (1395 University St, Eugene OR 97403) February 21: Oregon State Winter Career Fair, 11a-3p at Career Center (725 Southwest 26th Street, Corvallis OR 97331) April 17: Oregon State Spring Career Fair, 11a-3p at Career Center (725 Southwest 26th Street, Corvallis OR 97331) PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2022 alone we had 421 internal promotions! Certified Age Friendly Employer, 2023 | Age Friendly Institute Top Workplace 2023 and 2022 for Idaho | Idaho Press Top Workplace 2023 and 2022 for Oregon and SW Washington | The Oregonian #4 Healthiest Employer of Oregon 2021 | Portland Business Journal Healthy Worksite 2021 | Design Coalition in Montana PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email HR@PacificSource.com.

Salary : $44,538 - $71,260