Graham Healthcare Group

QA Engineer

• Meet quality and productivity standards and deadlines/turnaround times established by Hospice
• Perform daily HCHB workflow maintenance to ensure the medical record is compliant and up to date
• Review and compare daily reports to clinical staff documentation
• Review Medicare Part D response and denials documents and collaborate with the physician and clinical supervisors for accuracy
• Maintain working knowledge of Brand and Generic Medications for Hospice Patients and work collaboratively with Part D Sponsors to ensure correct payment for medications
• Collaborate with the Billing Department to ensure claims are complete with the appropriate medications.
• Perform claim medication review and entry of claim medications into the medical record
• Perform data entry of medications dispensed by the pharmacy and monitor the HCHB interface
• Ensure accurate and timely submission of HIS data and keep current on changing rules and regulations as related to HIS
• Communicate with the various insurance companies to ensure proper processes are being met, and ensure payments are correct
• Assist, when necessary, with planning and scheduling face-to-face visits with Nurse Practitioners and Hospice physicians to maintain compliance
• Perform Quality Assurance audits as directed

Hospice Quality Assurance Administrator