Clinical Quality Support Specialist

Job Summary

This position works under the direction of the Manager, Clinical Quality to provide non-clinical support for the Clinical Quality Department. Manages incoming and outgoing correspondence. Prepares documents and compiles data for meetings and workgroups. Tracks and conducts follow up to obtain requested documents for PQI review or focused studies.

Education & Experience

Required :

o High School Graduate or G.E.D. o 3+ years administrative experience or equivalent o Experience in a medical office, health insurance, or managed care organization o Proficient with Microsoft Excel, Word, Outlook o Ability to work in a multiple software programs

Preferred :

o Associates Degree in Business or Administrative Services o Medical terminology o Microsoft OneNote experience o Letter writing Experience

Key Responsibilities

• Orders / receives medical records for Potential Quality Issues (PQI and CQM Department activities according to desk procedures, conducts follow-up telephone calls to providers, and completes other processes to resolve missing documents.
• Obtains, prepares and distributes materials for quality meetings. Workgroups and projects as directed o Maintains all CQM department files to meet TriWest confidentiality and security requirements. o Processes invoices for medical records received. Follows up, as needed, with the Finance / Accounting Dept. o Processes incoming and outgoing mail and faxes, correspondence for overnight or certified delivery, and other mailing needs. o Participates in department meetings and work groups, serving on quality improvement committees as needed. o Performs other duties as assigned. o Regular and reliable attendance is required. o Supports department activities for Provider Credentialing Committee

Competencies

Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility : Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service : Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Independent Thinking / Self-Initiative : Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.

Multi-Tasking / Time Management : Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

Organizational Skills : Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Team-Building / Team Player : Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills : Working knowledge of functional TriWest departments and locations, Ability to work with sensitive and confidential information in the appropriate manner, Proficient at Excel, PowerPoint, and Word.

Working Conditions

Working Conditions :