About the Company
At Mac Care, we partner with healthcare businesses to support their software development, digital marketing, website development, back-office, and front-office needs. Our vision is to become the leading Knowledge Process Outsourcing provider focused on the U.S. healthcare industry. Our values of Innovation, Honesty, Compassion, Transparency, Accountability, and Respect guide our daily work. Mac Care is the exclusive Knowledge Process Outsourcing provider to Intra Care USA, a leading organization in U.S. healthcare, supporting over 100 physicians in their mission to improve senior patient health.
Job Summary
We are looking for a motivated Quality Improvement Specialist to enhance patient care through proactive outreach and coordination of health services. In this role, you will be responsible for managing patient referrals and facilitating communication between patients, providers, and health plans. Your expertise will help ensure that patients receive timely health screenings, assessments, and follow-up care. You will collaborate closely with healthcare teams to identify workflow improvements, track referral progress, and build strong relationships within the healthcare network, all while adhering to regulatory standards.
Key Responsibilities

• Conduct outreach to medical practices, providers, and patients, promoting health screenings, patient assessments, chronic condition management, and wellness visits.
• Engage directly with patients via telephone, addressing objections to compliance by providing education, facilitating resources, navigating benefits, and arranging necessary care.
• Collaborate with provider practices to identify workflow gaps and recommend best practices to enhance performance in clinical and quality metrics, including conducting field visits as needed.
• Closely monitor task completion, report progress, and ensure positive performance outcomes.
• Collect and enter data with meticulous attention to detail. Document information accurately, promptly, and completely, while maintaining records of customer interactions, demographic updates, and other critical details.
• Develop and maintain professional relationships with individuals and organizations that support Intra Care’s goals, including health plan representatives, provider practices, and internal departments.
• Conduct thorough medical record reviews and abstraction, scanning relevant components to support reviews. Organize and retrieve paper medical records as necessary to meet program objectives.
• Collaborate with Network and MSO departments to enhance quality outcomes and optimize customer satisfaction for both providers and patients.
• Maintain confidentiality and adhere to HIPAA requirements, including communication procedures, guidelines, and policies.
• Proactively identify and escalate gaps and issues to the supervisor or designated business owner.
• Establish a framework for tracking savings and compiling and reporting data effectively.
• Navigate vendor portals, electronic medical records, and internal systems to extract and process data as needed.
• Create executive reports and presentations to effectively communicate Key Performance Indicators (KPIs).
• Use organizational applications to ensure effective communication with employees and customers.

Additional Duties

• Perform other tasks as assigned to support team objectives.

Required Qualifications

• Graduate degree in a relevant field.
• Proven ability to manage multiple tasks and work efficiently under tight deadlines.
• Basic understanding of the healthcare industry.
• Strong professional conduct and communication skills, with proficiency in English.
• At least one year of experience with Microsoft Word and Excel, particularly for reporting.
• Software literacy to navigate various EMR interfaces.
• Independence and Problem-Solving: Demonstrated ability to work independently toward established goals, with strong attention to detail and problem-solving skills.
• Goal-Oriented Attitude: Target-oriented mindset with a willingness to learn and expand industry knowledge.

Preferred Qualifications

• Experience with Electronic Medical Records (EMRs).
• Relevant experience in the healthcare industry.
• Familiarity with medical terminology.
• At least one year of knowledge regarding HIPAA compliance requirements.
• Familiarity with Medicare programs, including Medicare Advantage, Medicare Shared Savings, and Accountable Care Organizations.

Location: Karachi, Pakistan
Working Hours: 6 PM – 3 AM (Night Shift)
Job Type: Full-time
Join us in making a meaningful impact on patient care through innovative value-based strategies!
Job Type: Full-time
Pay: Rs1.00 - Rs2.00 per month