Quality Improvement Specialist I - 210139

Location : Remote - TX only.

Duration : 3 months (but likely extended through April). Possible extension but not guaranteed (some may be extended for up to 1 year).

Shift : 8-5, no OT.

Walk me through the day-to-day responsibilities :

Primarily on the phone / emailing with medical offices / facilities confirming members and requesting medical records.

Documenting work in web portal and internal applications.

Performing claims research internally and web / google research to find most up-to-date information for providers.

Other projects as assigned including work in Excel, OneDrive & Teams.

Describe the performance expectations / metrics for this individual and their team :

Daily documented outreach to providers

What makes this role unique :

This role is best for someone who engages with their work, wants to grows in role and knowledge and is driven to go further. We encourage staff to think for themselves and solve problems. Each day will be different, and one size does not fit all for working our tickets. For example, if someone stays on hold for 45 minutes to speak to the correct person and is able to retrieve the needed charts, that is time better spent than someone who calls every day for 2 weeks and leaves voice mails. We want quality over empty quantity. We want to hear if staff tried something new or found a new method that works better than what we have. We always give credit where credit is due and encourage everyone including temp staff to submit process improvements.

What is the purpose of this team?

We are a Tier 2 problem solving / research / outreach team. We are NOT a call center. Our vendor will submit tickets to us when they run into an issue obtaining a medical chart from a medical office or facility.

Our job is to research and solve the problem and get the chart in.

Describe the surrounding team and key projects :

Our team culture is collaborative : staff post and answer each other s questions, they are encouraged to ask when they don t understand or need advice, FTEs are supportive and we have staff dedicated to helping new hires, daily meetings for social interaction and question answering. We have extremely low turnover in terms of FTEs and I have 7 temp workers currently who return year over year one has returned 5 times to work with us. We have 2 large chart chase projects each year for Medicare and Marketplace. Each project requests over 750K charts with a 90% retrieval goal which we always meet.

Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?

This request is part of our normal annual temp needs between Sep & Apr. Some may be extended for up to a year.

Candidate Requirements

Education / Certification

Required : high school diploma or GED

Preferred : Licensure

Required : Preferred :

Years of experience required :

Disqualifiers : Coder or Abstractor HEDIS or otherwise. This is NOT a coding position. This is a phone / email outreach & web research position.

Additional qualities to look for : Medical Office experience, Medical Records Clerk

• Top 3 must-have hard skills stack-ranked by importance

Customer Service Experience on the phone or in person must be comfortable calling provider offices

Good computer skills with more than Beginner Excel

Ability to work independently with minimal supervision / structure