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AI Summary
The Provider Review Services Coordinator manages data transformation tasks and oversees the planning, preparation, and finalization of provider review projects. They are responsible for maintaining audit databases, managing client communication, and ensuring data integrity throughout the review process.
Job Summary
This position focuses on managing tasks for provider review services with a primary emphasis in data management and transformation. The Provider Review Services Coordinator will assist with planning, preparing, overseeing and finalizing provider review projects in an efficient and timely manner.
Required Skills and Experience
- Substantial experience with ETL data transformation (extract, transform and load data, while ensuring its integrity)
- Experience with use of transformation tools such as OpenRefine, ASAP Utilities or Microsoft SQL
- Advanced Microsoft Excel skills (using functions and formulas, pivottables, analyzing data, etc.)
- Proficiency with additional Microsoft applications, especially Teams and OneNote
- ICD-10-CM, E&M, and CPT knowledge base preferred
- Demonstrates strong communication skills, both orally and written
- High level of interpersonal skills to handle sensitive/confidential situations and documentation
- Must be detail-oriented, organized, able to prioritize tasks and consistently meet deadlines
- Independent, focused individual with established work ethic
- High Speed Internet accessibility via Cable (no Satellite or wireless cell based)
Job Requirements
Review Projects
Review Projects
- assists with review prep calls, taking notes of client objectives for each audit
- creates project in audit database (Particle) and associated folders on secure portal (Nucleus)
- schedules review kickoff call with client and project lead
- manages contact list in Particle and assigns roles for access to secure portal
- creates/manages Microsoft Team and OneNote Notebooks for each client and updates with new policies as well as project specific details
Pull Lists – Provider Reviews
- checks files for accuracy of content, codes, missing information upon receipt, runs pivot tables
- formats data as necessary to obtain sample (uses data transformation utilities available)
- selects sample based on client parameters (focused, random, by coder, by provider, etc.)
- loads data into template and imports into audit database
Large Client Projects / Interim Projects
- tracks progress in spreadsheets for HIA and client weekly status updates
- prepares and imports pull lists for monthly interim projects
- assists with importing rebuttals, notifications to team lead
- may assist with running customized reports
Additional Tasks
- Runs Outstanding Tracking Report and sends to consultants for project completion or close out
- Assists with chart replacements during current projects (wrong patient type, combined accounts)
- Creates monthly interim projects in audit database
- Prepares and distributes client reports – as requested by manager
- Assists with scheduling internal HIA Reviewer QA reviews, importing chart samples
- Downloading files from secure portal to Sharepoint as needed (scanned record projects)
- Monitors remote access by consultant and facility, works with IT for follow up on outstanding access
Performance and Professionalism
- Maintains strict confidentiality and adheres to HIPAA guidelines
- Exhibits professional demeanor at all times
- Maintains communication by responding promptly to corporate office staff
- Demonstrates flexibility, open mindedness, and versatility in adjusting to changing environments
- Handles constructive feedback with a positive attitude
- Receptive to suggestions for changing or improving the way work is accomplished.
- Commits to continually improving his/her job skills
General Duties
- Maintains accurate expenses and timesheets
- Adheres to all HIA policies and procedures
- Maintains current information in personnel file
- Promptly returns all requested signed documents
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