Qlarant, Inc., is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country.

We have an exciting and challenging opportunity for a Healthcare Administrative Assistant (MR/PI Coordinator) in our Dallas office. It's a perfect opportunity for candidates possessing strong administrative/clerical skills, medical claims experience and knowledge of Medicare/Medicaid. This is an office based, hourly administrative/clerical position.

Working on our Unified Program Integrity Contractors team for the Southwestern Jurisdiction (UPIC Southwest), you can contribute to our efforts to make a positive difference in the future of our nation's healthcare programs. Our UPIC Southwest team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering 7 states.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

* Works with other CMS contractors to implement, revise and remove claims system edits.

* Work within the Medicare claims processing systems to monitor the status of UPIC initiated edits.

* Responsible for sending out correspondence, such as: educational letters, prepay notification letters, suspension correspondence.

* Responsible for monitoring and creating reports that show the results of system edits and present these findings at the Prepay Committee Meetings.

* Attend the UPIC Sample and Medical Review meetings.

* Initiates and maintains communication with the UPIC legal team, RFI Coordinator, and law Enforcement to manage the transfer of case/investigation information.

* Work closely with the UPIC legal team in response to FOIAs, RFIs, ALJ Hearings, Congressional Complaints, and other related activities.

* Responsible for tracking and creating reports related to the results of upper level appeals.

* Responds to client inquiries via written or oral communications.

* Work within internal and external tracking systems to monitor the status of payment suspensions, zone restrictions, and other cases or investigations as assigned.

* Responsible for monitoring and creating reports that indicate monitoring of identified administrative actions.

* Attend the UPIC Sample and Medical Review meetings and update tracking systems with information from the meeting.

* Work with the Lead MR nurses to compile and send out overpayment packets to the Medicare Administrative Contractors and providers.

* Coordinate and manage the transition of workloads, and serve as the interface with other entities.

* Creates reports on a monthly and ad hoc basis

* Provides training and technical advice to team members.

* Works with Quality Director/Officer on ISO initiatives to improve operational systems, processes and policies to improve information flow, management reporting, business process and organizational planning.

* Participates and/or leads internal/external committees as assigned.

To perform the job successfully, an individual should demonstrate the following competencies:

* Problem Solving - Identifies and resolves problems in a timely manner.

* Customer Service - Responds promptly to customer needs; Responds to requests for service and assistance.

* Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Includes appropriate people in decision-making process.

* Planning/Organizing - Prioritizes and plans work activities; Organizes or schedules other people and their tasks.

* Mathematical Skills - Ability to calculate figures and amounts such as addition, subtraction, multiplication, division, proportions and percentages.

* Reasoning Ability - Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

* Oral Communication - Speaks clearly; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

* Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

* Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources.

* Computer Skills - knowledge of Database software; intermediate proficiency with Excel, Access, PowerPoint and Word Processing software.

Education and/or Experience

* High school diploma or GED required, Associates Degree in business preferred;

* At least 1 year experience in an administrative position; or an equivalent combination of education and experience.

* Prior experience with medical claims processing a plus.

* Must possess a general understanding of Medicare and Medicaid.

* Prior experience working on government contracts preferred.

* Working knowledge of Medicare and/or Medicaid protocols for Fraud and Abuse investigations preferred.

* Intermediate level Microsoft Office (Word, Excel and Outlook) skills and proficiency in the use of database software

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.