Peer-to-Peer Coordinator at TurningPoint Healthcare

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Full Time

Start Date

Immediate

Expiry Date

30 Sep, 26

Salary

0.0

Posted On

02 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Peer Review Coordination, Customer Service, Healthcare Operations, Verbal Communication, Written Communication, Organizational Skills, Problem Solving, Microsoft Word, Microsoft Excel, Microsoft Outlook, Data Entry, Case Management, HIPAA Compliance, URAC Standards, Teamwork, Presentation Skills

Industry

Hospitals and Health Care

Description

Peer-to-Peer Coordinator Shift Hours: 9:00 am - 6 pm EST Who We Are: TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system. Position Summary: The Peer-to-Peer Coordinator is responsible for coordinating and supporting medical staff peer review activities between the medical director(s) at TurningPoint and the medical director(s) for the associated practices and/ or plans. Roles and Responsibilities: * Manages peer review process to include: * Identification of peer review cases through report review, occurrence report follow up, and complaint investigation. * Initial investigation of potential cases to include follow up with involved physicians, Advanced Practice Providers (APPs) or other staff. * Presentation of cases as indicated in the peer review policy. * Closure of cases in the appropriate documentation system. * Communication at all levels of the organization as defined by policy. * Maintains responsibility for reporting up/ out any general education needs related to findings. * Demonstrates ability to function autonomously or in a self-directed capacity. * Ensure high priority in delivering service excellence both independently and across the team, to include interacting closely with internal and external clinical providers. * Answer client/ customer inquiries and develop action plans for any identified areas of improvement. * Provide satisfactory resolutions to provider issues escalated from the Clinical Operations Representatives/ Clinical Review Nurses. * Monitor and maintain the key performance indicators as outlined by management. * Support Clinical Operations with working the phone queue and creating cases, especially during peak/ overflow periods. * Serve and protect the company by adhering to URAC standards, professional standards, policies and procedures, federal, state, and local requirements, and professional and licensing standards. * Participate in educational opportunities, read professional publications, maintain personal networks; participate in professional organizations. * Enhance company reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments. * Follow company policies and procedures and conducts annual performance reviews in a timely manner. Respects and maintains HIPAA confidentiality guidelines. * Other duties as directed. Education, Knowledge and Experience: * Minimum of 2 years’ experience in Customer Service, or any healthcare operations is required * Excellent verbal and written communication skills * Must possess strong organizational skills; ability to multitask; commitment to customer service; ability to problem solve * Must be able to foster a positive and productive work environment * Bachelor’s Degree in a business or health related field is preferred * Phone Queue Experience and Data Entry Skills Preferred Skills: Creating a Safe, Effective Environment, Verbal Communication, Listening, Confidentiality, Dependability, Emotional Control, Teamwork Strong organizational skills; commitment to customer service; ability to problem solve; strong presentation skills throughout all levels of the organization. Must be able to foster a positive and productive work environment with ability to lead, build teams and motivate staff. Proficient in Microsoft Word, Excel and Outlook. TurningPoint Healthcare Solutions is an Equal Opportunity Employer.

Responsibilities

The Peer-to-Peer Coordinator manages the medical staff peer review process, including case identification, investigation, and closure. They act as a liaison between medical directors and external providers to ensure service excellence and adherence to clinical standards.