Claim specialist Jobs in Tucson, AZ

Join Suvida Healthcare

At Suvida Healthcare, we are not just caregivers; we're compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well-being of an underserved community and their families. Our multi-disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare-eligible Hispanic seniors.

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both, our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service-centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos, to help achieve our Higher Purpose?

We are an empowered primary care team, clinical operations, and support team creating health equity through an exceptional clinical and consumer experience that improves the quality of life for the people, families, and neighborhoods we serve. We tailor our primary care program to the culture, language, social, and overall well-being of the seniors we serve.

Our Culture & Core Beliefs

• Earn Trust
• Building Relationships
• Creating Joy
• Doing Right
• Improving Every Day
• Moving Forward

Our Promise

• Purpose Driven Career
• Competitive Pay
• Best-In-Class Medical/Dental Coverage
• Free Mental Health & Life Coaching for Team Members and their Dependents
• Holiday Time Off with Pay
• Paid Community Service Day
• Paid Parental/Family Leave
• Paid Bereavement Leave
• Generous Paid Time Off (PTO)
• 401k Retirement Plan with Company Match
• And much more...

Position Summary

The Specialist, Quality will work closely with our clinic staff to identify gaps in care, capture HEDIS documentation, perform chart audits, track patient engagement in care gap, and notify clinics of time sensitive care caps. They will also work with the Director of Quality to report low clinic engagement, opportunities for staff education, and reporting inaccuracies. Essential responsibilities consist of, but are not limited of the following:

• Identify and notify clinical staff of next steps needed to address open quality gaps.
• Submit documentation to payer portal to close quality gaps.
• Audit supplemental data to ensure results are compliant for identified measures.
• Educate staff and providers on HEDIS technical specifications.
• Resolve clinical staff Quality inquiries.
• Join daily huddles as needed to inform clinical staff of patients with outstanding time sensitive measures.
• Collaborate with other departments on quality specific projects to help reach quality goals.
• Actively participate as a team player to promote positive health outcomes for our patients.
• Able to work Monday-Friday from 8-5PM local time and be in the Arizona area.
• Be willing to take on additional task to support the overall success of the organization.

What You'll Bring

Education Requirements

• Bachelor's degree in healthcare administration or public health required

Certifications Requirements

• One of the following certifications, accompanied by 2+ years of experience in value-based care setting (primary care or Medicare Advantage Plans preferred):
• Certified Medical Assistant
• Certified Pharmacy Technician
• Certified Nursing Assistant
• NCQA certification
• OR

Experience Requirements

• 4+ years of experience in value-based care setting (primary care or Medicare Advantage Plans preferred)
• 2+ years of HEDIS or Risk Adjustment experience in supplemental data and chart reviews
• Knowledge of CMS STARS program
• Must have a basic understanding of billing and claims coding
• Experience reviewing Electronic Medical Records
• Intermediate level experience in working in Microsoft Excel, Word, and PowerPoint
• Experience navigating payer portals.
• At least 1 year of experience utilizing medical terminology.

Skill Requirements

• Ability to work independently
• Strong problem-solving skills with the ability to identify solutions independently and know when to appropriately escalate complex issues
• Ability to multi-task
• Ability to work in fast paced environments with changing priorities.
• Bilingual (English/Spanish) preferred

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.