iMPROve Health · 15 hours ago
PROJECT SPECIALIST - HEALTHCARE - REMOTE
United States
Full-time
Remote
Entry, Mid Level
$50K/yr - $60K/yr
2+ years expiMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, dedicated to improving healthcare across the continuum of care. The Project Specialist assists with daily workflow administrative responsibilities that support the Federal Independent Dispute Resolution Entity review process, ensuring case timeliness and collaborating with the IDRE team and external customers.
Health CareMedicalNon Profit
Responsibilities
Assist the team with facilitating review requests in a timely and efficient manner, including implementing processes to track and monitor individual case progress and timeliness
Collaborate with IDRE team members to achieve department goals, including prescreening IDR (Independent Dispute Resolution) cases for eligibility using defined criteria
Apply knowledge and experience in claims, appeals, and denials to support review and resolution processes, ensuring accuracy, compliance, and timeliness
Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review and claims-related portals
Work closely with the administrative assistant to ensure receipt and completeness of all review documentation
Develop materials such as forms, email correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity
Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events
Utilize advanced computer skills for daily work; responsibilities require constant computer usage and proficiency in software programs such as Microsoft Office, all Windows software products, and web-based portals
Participate in portal development and enhancements, including testing and feedback to improve functionality and user experience
Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare & Medicaid Services, Federal Acquisition Regulation (FAR))
Complete other duties as assigned
Qualification
Required
Associate's degree or five (5) years of related experience required; Bachelor's degree preferred (healthcare specialty preferred)
Minimum two (2) years of project support experience in a corporate or professional environment required
Project management skills required
Strong communication skills, both verbal and written, required
Strong multi-tasking skills with attention to detail and deadlines required
Preferred
Bachelor's degree preferred (healthcare specialty preferred)
Experience in IDR or claims, appeal, and denial processes preferred
Benefits
Medical
Dental
Vision
Life insurance
Short- and long-term disability
Generous 401(k) match
Company
iMPROve Health
iMPROve Health is a nonprofit organization that specializes in healthcare quality improvement and medical review.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Amanda Weted, MHRLR, PHR, SHRM-CP
Vice President & Chief Human Resources Officer
Company data provided by crunchbase