Clinical - Quality Improvement Specialist I - 210139

Job Description :

Job Tittle : Quality Improvement Specialist I

Location : Remote - TX

Duration : 3 Months (Possible Extensions)

Shift : 8 AM 5 PM CST, Monday to Friday

Position Summary

The Quality Improvement Specialist is responsible for conducting outreach to medical offices and facilities to obtain member medical records, resolve barriers to chart retrieval, and support large-scale chart chase initiatives for the company. This role involves problem-solving, research, communication with provider offices, and accurate documentation within internal systems. This is not a call center or coding role.

About the Team

This is a Tier 2 research and problem-solving team , not a high-volume call center. The team receives tickets from a vendor when challenges arise in obtaining medical charts. The Specialist investigates the issue, performs outreach, and ensures successful chart retrieval.

The environment is collaborative, supportive, and highly engaged , with daily team meetings, shared knowledge, and strong peer support. Many contractors return year after year due to the positive work culture.

The team manages two major chart chase projects annually for Medicare and Marketplace, each requiring retrieval of over 750,000 charts with a 90% success goal consistently met.

Key Responsibilities

• Conduct outbound phone calls and email outreach to medical offices and facilities to request and obtain medical records.
• Verify member information and clarify chart requests with provider offices.
• Perform internal claims research and external web-based research (Google, provider searches) to identify accurate provider contact information.
• Document all outreach and actions in internal systems, web portals, and applications.
• Collaborate with teammates to resolve complex retrieval barriers.
• Utilize Excel, OneDrive, and Microsoft Teams to manage work and assist with additional assigned projects.
• Apply independent judgment and creative problem-solving to resolve provider issues efficiently.

Performance Expectations

What Makes This Role Unique

Required Qualifications

Preferred Qualifications

Disqualifiers