Medical Claims Review Manager jobs in Columbia, SC

Quality Improvement Advisor- Clinical Practice

CMS 12^th Statement of Work Program

Remote Contract Employment

Who We Are

Constellation Quality Health, formerly Carolinas Center for Medical Excellence (CCME), is recognized as a leader in improving health care quality, by providing innovative services and solutions to create healthier communities in South Carolina. We achieve this by implementing best-practices and proven solutions to improve population health, utilizing CMS administrative claims and provider reported data, ensuring private practices and networks of providers have access to the latest technology and data-driven analytics. With over 40 years of health care quality improvement experience, Constellation Quality Health is an established entity in quality improvement.

What You’ll Do

We are seeking a high performing quality specialist with experience collaborating with Clinician Practices to achieve better health outcomes for Medicare beneficiaries.

We expect you to:

• Assist in improving patient experience and better care coordination in high-risk populations with high chronic disease burden.
• Collect and analyze provider reported quality data
• Provide technical assistance through workflow analysis, EHR mapping and appropriate coding to maximize payment.
• Have diverse knowledge of innovative care models in rural primary practice

Who You Are

This position is a quality professional who demonstrates an array of quality improvement expertise, can lead successful change and achieve improvement in the clinical practice environment. The quality improvement advisor role requires knowledge of the implementation and application of quality improvement methodologies to assist clinicians with projects to improve quality of care and patient safety. The position requires the ability to assess and solve problems, develop innovative approaches, convene and lead groups in planning and goal setting. The successful advisor for this position should have exceptional oral and written communication skills.

This opportunity is a work from home role. Prefer candidates located in South Carolina.

Our requirements for this role:

• Bachelor’s degree in related health care field required, Master preferred.
• Certifications in CPHQ or Patient Centered Medical Home (PCMH) or Medical Records Coding.
• Advanced knowledge of Electronic Health Record workflow and utilization of EHR data base/registries is required.
• Five (5) years’ experience in healthcare setting, preferable clinical practice settings.
• Excellent communication skills, both written and oral.
• Utilize technology, such as MS Teams and virtual meeting platform with limited assistance.
• Basic understanding of data management and ability to make professional presentations.

Why Constellation Quality Health?

We offer a competitive salary and benefits package and a flexible work environment.

Equal opportunity employer of protected veterans

Equal opportunity employer of individuals with disabilities

We do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, gender identity, national origin, medical condition, disability, veteran status, or any other basis protected by law.

Applicants and employees are protected from discrimination based on inquiring about, disclosing, or discussing compensation or the compensation of other applicants or employees.