ACO Transition & Quality Metrics Specialist

Hackensack Meridian Health; Hackensack (NJ); On-site; USD 28,000 - 39,000; Full time

Job summary

Hackensack Meridian Health in New Jersey seeks a Transition Assistant, Accountable Care Organization to support quality metrics, patient transitions, and payer program reporting across ACO offices in New Jersey.

This role involves auditing clinical records, designing compliant workflows, training staff, and delivering monthly reports to improve care coordination and maximize shared savings opportunities in a collaborative healthcare environment.

Qualifications

• Associate's degree or relevant years in healthcare, medical insurance billing, auditing or related field.
• Excellent analytical skills.
• Good reasoning and problem solving ability.
• Highly developed interpersonal skills.
• Proficient at multi-tasking and prioritization.
• Ability to work independently as well as in a team environment.
• Highly organized.
• Good presentation skills.
• Demonstrated proficiency with PC and Microsoft office skills. Ability to learn and become proficient in ACO electronic medical records and ACO software applications.
• Registry skills.
• Experience with auditing commercial medical insurance payers.
• Bilingual in Spanish.
• Experience in a variety of patient settings.

Responsibilities

• Audit clinical records for gaps in quality care metrics and create corrective plan with ACO practice to facilitate collections and reporting of required quality metrics.
• Train, educate and update ACO physicians and staff on payer program metrics.
• Assist in workflow design that promotes compliance to ACO standards and clinical quality metrics.
• Provide monthly reports to practice to assist with quality metric performance that will maximize shared savings opportunities.
• Work with providers, care coordinators and office staff to ensure safe patient transitions.
• Accountable for preventative care metric documentation.
• Contacts ACO patients to make appointments for outstanding provider follow ups, labs and diagnostics as directed by ACO providers.
• Performs both internal and external audits for Medicare, Aetna, Horizon, Qualcare payers. Communicates gaps in quality metrics to providers and ACO management on a monthly basis.
• Assist practice in scheduling appointments and referrals which improves accessibility of office services and patient satisfaction.
• Travel to assigned ACO offices to ensure compliance with ACO policies and procedures as directed by ACO management.
• Work with management and care coordinators to utilize ACO software to create and report on ACO outcome measures such as ER, inpatient and sub-acute usage.
• Audit medical records to ensure documentation conforms to CMS standards for inclusion and exclusionary clinical guidelines.
• Identifies the needs of the patient population served and modifies and delivers care that is specific to those needs (i.e., age, culture, language, hearing and/or visually impaired, etc.). This process includes communicating with the patient, parent, and/or primary caregiver(s) at their level (developmental/age, educational, literacy, etc.).
• Adheres to the standards identified in the Medical Center's Organizational Competencies.

Skills

Analytical skills

Interpersonal skills

Multitasking

Time management

Presentation skills

Microsoft Office

Teamwork

Independent worker

Education

Associate's degree or relevant years in healthcare

Tools

ACO EMR software

Job description

Hackensack Meridian Health in New Jersey seeks a Transition Assistant, Accountable Care Organization to support quality metrics, patient transitions, and payer program reporting across ACO offices in New Jersey.

This role involves auditing clinical records, designing compliant workflows, training staff, and delivering monthly reports to improve care coordination and maximize shared savings opportunities in a collaborative healthcare environment.