Transition Assistant, Accountable Care Organization

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

Description

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

Responsibilties

A day in the life of a Transition Assistant, Accountable Care Organization at Hackensack Meridian Health includes:

• 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.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• 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.

Education, Knowledge, Skills And Abilities Preferred

• Registry skills.
• Experience with auditing commercial medical insurance payers.
• Bilingual in Spanish.
• Experience in a variety of patient settings.

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

Job Duties

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

• Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
• Experience: Years of relevant work experience.
• Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
• Skills: Demonstrated proficiency in relevant skills and competencies.
• Geographic Location: Cost of living and market rates for the specific location.
• Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
• Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.

Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.Minimum rate of $24.34 Hourly