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Position:Qualification Coordinator IIIDepartment: Referral ManagementReports to: &nbsp;Qualification SupervisorPosition Description:The Qualification Coordinator III is responsible for accurately processing all assigned referrals. The Qualification Coordinator III acts as a liaison to facilitate communication between referral sources, patients, and the health care agencies. The Qualification Coordinator III maintains accurate records in compliance with applicable laws and regulations and the policies of tango.Office Location:Office located at 7600 North 16th Street, Suite 140 Phoenix, AZ 85020 (Remote)Responsibilities and Duties:Responsibilities of the Qualification Coordinator III include, but are not limited to the following:<ul><li>Receive referrals and enter all applicable information regarding the patient referrals into referral management system including but not limited to: patient demographics, contact information, disciplines requested and all necessary medical information to affirm appropriate patient care</li><li>Ensure all attached documents are HIPAA compliant for each referral processed. </li><li>Identify and process expedited requests immediately and communicate the priority status to all appropriate internal teams.</li><li>Verify insurance eligibility for each patient through software automation, running insurance manually through payor websites when needed. </li><li> Contact appropriate parties (patient and/or referral source) of prior authorization decisions; including but not limited to approvals, requests for more information or not able to process due to insurance.</li><li>Call agencies to coordinate continuance of patient services.</li><li>Ensure service requests include all required documentation and that services approved are appropriate based on documentation provided.</li><li>Contact patients and referral sources to obtain any additional information needed and inform of referral processing outcomes.</li><li>Identify and escalate referrals for medical review to the clinical team and follow through on the resolution of each referral.</li><li>Upon approval of referrals, apply the appropriate visits/disciplines to the patient referral per the patient’s demographic area.</li><li>Properly document patient records with the use of notes within the Tempo system and maintain required logs. </li><li>Accurately follow up on patient referrals as needed. </li><li>Adhere to all company policies and procedures</li><li>Adhere to performance expectations</li></ul>Qualifications:<ul><li>Must be at least 18 years of age.</li><li>High School Diploma or GED, some college</li><li>Medical Assistant with at least 2 years of experience working in a Medical Facility. </li><li>Has extensive knowledge and experience including but not limited to: Microsoft Word, Microsoft Excel, Adobe PDF, and ability to navigate computer systems efficiently.</li><li>Typing speeds &gt;60 WPM with &gt;95% Accuracy.</li><li>Reading speeds &gt;250 WPM with &gt;90% Comprehension.</li><li>Must be flexible and willing to work weekends and Holidays.</li><li>Detail oriented and displays good organizational skills. </li><li>Must be able to sit for long periods in front of computer.</li><li>Must have reliable internet service</li></ul>Proven Personal Attributes:<ul><li> Manage and prioritize multiple tasks effectively and efficiently while working home health referrals. </li><li> Able to apply critical thinking skills to review referrals and determine if they meet the medical necessity criteria.</li><li> Demonstrate empathy and compassion when communicating with patients regarding authorization decisions.</li><li> Proactive in identifying and resolving any issues or challenges that may arise during the referral management process. </li><li> Self-directed, flexible, cooperative, and exhibits the ability to work with minimal supervision.</li><li> Capable of following an issue through to its conclusion.</li><li> Maintain a growth mindset on improving knowledge in referral management practices.</li><li> Able to remain calm under pressure and manage stressful situations.</li><li> Provide excellent and professional customer service skills with a positive, patient, and friendly attitude.</li><li> Able to establish highly productive and detailed organizational skills/habits.</li><li> Possess strong, professional written and oral communication skills for in-person, telephonic, and electronic use.</li></ul>tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

tango

Coordinator, Qualification III (Remote)

tango is a leader in the home care health management industry and is preparing for significant growth! We are hiring a Claims Operations Manager to join our team. The Claims Operations Manager is responsible for coordinating work of subordinate employees engaged in medical billing, medical claims payment activities, customer service call center and claims reporting.&nbsp; The Claims Operations Manager is responsible for ensuring accuracy and compliance with claims policies and procedures, SLA are met, report key metrics internally/externally, and bringing the concerns of claims billing to the attention of tango’s Claim Leadership.&nbsp;&nbsp; This job is ideal for someone who is dependable, adaptable, and flexible, who enjoys doing work that requires a face pace, frequent shifts in direction, detail-oriented, achievement-oriented, taking on challenges, even if they might fail, and someone who is autonomous and independent.Responsibilities:&nbsp;<ul><li> Establish and maintain relationships with other departments that have visibility to claims</li><li> Serves as the primary point of contact for internal and external stakeholders regarding claims, addressing inquiries, concerns and providing education about claims processes, timeliness and potential follow up</li><li> Oversight of provider/payor customer service and provider education.</li><li> Evaluate/monitor all data integrity and escalate to leadership when risks are identified.</li><li> Monitor effectiveness by performing technical analysis to track/trend bugs/manual work arounds to recommend enhancements and improve ROI </li><li> Ensure compliance with regulatory guidelines is met by maintaining automated processes to mitigate risk (Medicare CMS, Federal/State Laws etc.)</li><li> Responsible for the recruitment, retention, and development of claims staff</li><li> Oversee claims operations performance including paper &amp; electronic claims receiving, processing, adjudication, payment/denial and EOP to providers</li><li> Oversees Encounter file transmissions including EBT, DPT reporting and handling of rejections in the contractual required time frame</li><li> Identify opportunities for improving processes to improve productivity and quality.</li></ul>Qualifications:<ul><li> Bachelor’s degree in business, Healthcare Administration or a related field</li><li> Deep knowledge in Medicaid EVV including encounter transmissions highly preferred</li><li> Knowledge of medical reimbursement methodologies and terminology</li><li> Excellent written and verbal communication skills</li><li> Knowledge of 835/837 reporting (Preferred)</li></ul>Essential Skills:<ul><li> Excellent interpersonal, communication and organizational skills</li><li> Excellent knowledge of claims reporting based on Service Level Agreements (SLA) and Medicare CMS requirements</li><li> Excellent planning, organizing, and managing skills with claims operations department employees &amp; supervisors</li><li> Ensure customer needs are identified, monitored, and practices modified to maximize customer satisfaction within established standards</li><li> Motivate, facilitate, mentor and coach subordinates to deliver high-quality, cost-effective services</li><li> Strong technical/system skills preferred-intermediate knowledge of Microsoft Office suites, including Power BI</li></ul>Experience:<ul><li> 5 + years of progressively responsible supervisory experience </li><li> 10+ years in claims processing and or billing </li></ul>Physical Requirements:The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.<ul><li>Prolonged periods of sitting at a desk and working on a computer.</li><li>Must be able to access and navigate each department at the organization's facilities.</li><li>Must be able to host Provider Webinars and Training and participate in Payor Audits</li></ul>Job Type:<ul><li> Full-time </li><li> Remote, willing to travel to AZ office quarterly</li></ul>Compensation: TBDBenefits: TBDtango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

Manager, Claims Operations (Remote)

The Referral Sources Manager is responsible for creating and maintaining relationships, as a conduit between external referral source partners and the tango Referral Management leadership and bringing the concerns of referral sources to the attention of tango’s Referral Management leadership. The role will involve educating referral sources on tango processes, expectations, and the benefits of working with tango.&nbsp;&nbsp;Key Responsibilities:Responsibilities of the Referral Sources Manager include, but are not limited to the following:Relationship Management:&nbsp;<ul><li><ul><li> Establish and maintain relationships with key referral sources, including hospitals, physician groups, clinics, Skilled Nursing Facilities, and case managers.</li><li> Serve as the primary point of contact for referral sources, addressing inquiries, concerns, and providing education about our processes, timelines, and potential follow-up</li><li> Serve as the primary point of contact for health plans requesting support to address referral source inquiries, concerns, and education needs about tango’s processes, timelines, and potential follow-up requests.</li></ul></li></ul>Education and Promotion:&nbsp;<ul><li><ul><li>Educate healthcare providers and other referral sources on the company's referral process by attending or leading educational webinars intended to provide an overview of what is required to place a member.&nbsp;</li><li> Provide ongoing support to high profile referral sources, including participating in committee meetings with health plans and tango business partners.</li><li>May attend industry or health plan sponsored events, conferences, and networking functions to represent the company and educate referral sources</li></ul></li></ul>Collaboration with Clinical Team:&nbsp;<ul><li><ul><li>Work closely with tango staff to ensure patient care aligns with the needs and expectations of referral sources.&nbsp;</li><li>Communicate effectively with tango staff to address any issues raised by referral partners and resolve them promptly.</li></ul></li></ul>Data Management and Reporting:&nbsp;<ul><li><ul><li>Provide regular reports to senior management on referral patterns, market trends, and performance metrics.</li><li> Provide reporting to referral sources regarding in response to concerns raised</li></ul></li></ul>Compliance:&nbsp;<ul><li><ul><li>Ensure all marketing and referral activities follow healthcare regulations, including HIPAA and state laws.</li></ul></li></ul>Qualifications:<ul><li> Bachelor’s degree in business, Healthcare Administration, Marketing, or a related field.</li></ul>Skills:<ul><li> Excellent interpersonal, communication, and negotiation skills.</li><li> Strong organizational and time management abilities.</li><li> Ability to analyze data and market trends to make informed decisions.</li><li> Proficient in Microsoft Office Suite.</li></ul>Preferred Qualifications:<ul><li>Minimum 2 years' Experience in home health or a related healthcare field.</li><li>Knowledge of the local healthcare market and key players.</li></ul>Additional Requirements: <ul><li> This position requires local travel to referral sources and occasional attendance at events outside normal business hours.&nbsp;</li><li>A valid driver’s license and reliable transportation are required.</li></ul>Proven Personal Attributes:<ul><li>Ability to multitask in a fast-paced work environment.</li><li>Ability to remain calm under pressure and manage stressful situations.</li><li>Provide excellent and professional customer service skills with a positive, patient, and friendly attitude.</li><li>Ability to maintain a high level of confidentiality and remain HIPAA compliant.</li><li>Ability to establish highly productive and detailed organizational skills/habits.</li><li>Ability to motivate others and project a positive attitude.</li></ul>Job Type:&nbsp;Full time&nbsp;tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

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