Medicaid Eligibility QA Specialist WFH in Creve Coeur, MO at Parallon

Date Posted: 6/17/2018

Job Snapshot

Job Description


  1. Perform quality assurance activities for Medicaid eligibility operations to ensure that work efforts satisfactorily meet customer requirements in a systematic, reliable fashion, effectively using systems to do so.
  2. Perform analytical assessments of data and assist the management team in using the data for decision-making purposes.
  3. Maintain prompt and accurate documentation outlining all steps of the QA program that have been taken in individual organized files.  Complete the proper forms.  Audit the assigned number of accounts per day following a set schedule.  Forms will be completed and submitted within required timelines.
  4. Work independently with various departments to ensure revenue is maximized.
  5. Maintain reports that are indicative of process improvement within departments while promoting a positive presence in improving these processes.
  6. Make recommendations based on assessments that improve production and quality.
  7. Ability to multi-task to ensure day-to-day work is complete as well as assigned projects.
  8. Coordinate QA findings with appropriate departments, internal or external, and ensure that necessary follow up is done to resolve any negative results.
  9. Provide documented results and process improvement to Director for departments not meeting company/client standards.
  10. Performs all other duties as assigned
  11. Duties may vary by location

Job Requirements

  1. Knowledge: Proficient knowledge of Government Assistance Programs, including Medicaid/Medi-Cal and SSI/SSD and the application process for each to ensure successful conversion of accounts.  Familiarity with Medicaid billing and reimbursement processes including retro-certification process desired. Capable of meeting production quotas. Ability to resolve problems and make recommendations for process improvement.   
  2. Experience: A minimum of 3 years’ experience within Medicaid Eligibility, preferably as both a hospital-based screener and an application processor.  Experience with standard suite of Microsoft office software products.  Intermediate to advanced proficiency with Excel and Word required.
  3. Skills/Aptitudes: Demonstrated analytical, communication and problem solving skills and the ability to act/decide accordingly.  Ability to collect, create and research complex or diverse information. The ability to plan, organize and exercise sound judgment. 
  4. Travel: Disclaimer: The above statements are intended to describe the general nature and level of work being performed.  They are not intended to be an exhaustive list of responsibilities, duties and skills required.