TMF Health Quality Institute

Team Lead

TMF Health Quality Institute  •  Austin, TX (Onsite)  •  20 days ago
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Job Description

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**

*This position is located Remote United States*

Position Purpose:

Provides subject matter expertise to staff and decision makers through technical support and one-on-one training

Essential Responsibilities:

  • Serves as a lead staff member and subject matter expert for Appeals Specialists, Clerks, Dispute Resolution Analyst, Intake Specialists, LEP Analysts, and/or Reconsideration Analyst.
  • Uses subject-matter knowledge and judgment related to contract processes to carry out automated tasks or reopening case file requests.
  • Assists with questions related to the contract or project. This may include, but is not limited to, corrections and detailed explanations as to how to properly comply with Centers for Medicare & Medicaid Services (CMS) guidelines.
  • Assists in ensuring the staff or department is meeting goals in support of the contract and company policies.
  • Assists in facilitating meetings, including staff meetings to discuss quality measures and provide training.

Minimum Qualifications

Education

  • High School diploma or equivalent

Experience

  • Three (3) years general office experience
    • College education or technical training in administration, business, or related areas may be substituted for experience on a year per year basis. (Education requirements may be satisfied by full-time education or the prorated part-time equivalent.)
  • One (1) year Mailroom, Medicare appeals, Managed Care appeals, Healthcare or Health Insurance industry
  • Managed Care, preferred
  • Quality Letter System (QLS), preferred
  • Medicare Appeal System (MAS), preferred

Benefits

C2C offers an excellent benefits package, including:

  • Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
  • Section 125 plan
  • 401K
  • Competitive salary
  • License/credentials reimbursement
  • Tuition Reimbursement

EOE Vet/Disability

TMF Health Quality Institute

About TMF Health Quality Institute

Improving Lives by Improving the Quality of Health Care

TMF Health Quality Institute focuses on promoting quality health care through contracts with federal, state and local governments, as well as private organizations. For more than 50 years, TMF has helped health care providers and practitioners in a variety of settings improve care for their patients.

TMF was chartered in 1971 as a private, nonprofit organization of licensed physicians (MDs and DOs) to lead quality improvement and medical review efforts in Texas. Originally known as the Texas Medical Foundation, the company changed its name to TMF Health Quality Institute in 2005 to reflect the expansion of its work throughout the nation.

In 2011, TMF acquired C2C Innovative Solutions, Inc., a Medicare Qualified Independent Contractor with offices in Florida and employees throughout the nation. This acquisition expanded TMF’s scope of services and increased our presence in the government contracting market. C2C specializes in providing health care sector support and administrative services in the handling of Medicare second-level appeals.

In 2013, TMF established the TMF Foundation in support of TMF’s vision to improve lives by improving the quality of health care. The TMF Foundation provides resources and educational support to organizations focused on the health of Texas residents. Recently, the foundation joined an effort to affect the trend of childhood obesity.

We partner with health care providers in multiple settings:

•Hospitals

•Physician Offices

•Nursing Homes

•Home Health Agencies

•Medication Safety and Reduction of Adverse Drug Events

TMF partners with health care providers to ensure that every patient receives the right care… every time.

Industry
Healthcare & Social Services
Company Size
201-500 employees
Headquarters
Austin, Texas
Year Founded
1971
Website
tmf.org
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