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PacificSource Health Plans · 22 hours ago

Quality Program Specialist - Temp

Bend, OR

Full-time

Onsite

Entry Level

$45K/yr - $72K/yr

2+ years exp

PacificSource Health Plans is dedicated to helping members access quality, affordable care. The Quality Program Specialist will manage medical record requests, ensuring compliance with HIPAA regulations while maintaining the accuracy and quality of medical records.

CommunitiesCustomer ServiceNon Profit

H1B Sponsor Likely

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 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

Management of member records including file storage that’s in alignment with HIPAA laws and regulations and in compliance with Business Associate Agreements

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

Qualification

HIPAA regulationsMedical terminologyICD-10-CMCPTMedicare quality programsAnalytical skillsOrganizational skillsCommunication skillsProblem SolvingTeamwork

Required

2 years of experience in the health insurance or medical industry required or equivalent education/experience

High school diploma or equivalent required

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

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

Preferred

Experience with Medicare preferred

Associate degree preferred

Knowledge/experience with Medicare quality programs (CMS 5-Star, HEDIS, risk adjustment) preferred

Company

PacificSource Health Plans

Founded in 1933, PacificSource is a not-for-profit health insurer for people and organizations throughout the Northwest.

Founded in 1933

Springfield, Oregon, USA

1001-5000 employees

http://www.pacificsource.com

H1B Sponsorship

PacificSource Health Plans has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (6)

2024 (4)

2023 (2)

2022 (4)

2021 (5)