Clinical Quality Specialist (52644)

Job DetailsJob Location: Any Location Remote US - Oklahoma City, OK 73102Position Type: Full TimeEducation Level: High School or EquivalentTravel Percentage: OccasionalJob Shift: DayJob Category: Customer ServiceWHO WE ARE: GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value, and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning. WHO YOU ARE: The ideal candidate will perform tasks associated with quality initiatives to improve member care. Ensures the effective management of care gaps, including data entry, referral tracking and telephonic member and provider outreach. ESSENTIAL JOB FUNCTIONS: Supports and maintains outreach initiatives with members and providers. Effectively educates providers on quality metric guidelines to enhance patient compliance. Performs accurate data entry in HEDIS software system and outreach tracking system. Reviews and maintains medical records to identify, confirm, and/or document referrals, results, and appropriate medical coding. Conducts record audits at remote provider offices. Maintains detailed technical understanding of HEDIS, CAHPS, HOS, and Meaningful Use measures set by CMS performance standards Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. Performs other duties as assigned. EDUCATION AND EXPERIENCE: High School diploma or equivalent required Current Certified/Registered Medical Assistant in State of Oklahoma or six months of experience with a health plan or within a quality department or clinical setting required. Valid state Drivers License, reliable personal vehicle and proof of personal vehicle liability insurance required. KNOWLEDGE, SKILLS AND ABILITIES: Computer literate and familiar with Microsoft applications (Word, Excel) Basic electronic health record knowledge and ability to quickly learn new software Detailed knowledge of quality performance measures and clinical health care Strong organizational and time management skills Strong verbal and written communication skills WORKING CONDITIONS: Prolonged sitting at a desk using telephone and computer. Frequent and repetitive keyboard use. Work involves standing and walking for brief periods of time. Work requires normal vision and hearing as might be required in typical conversation use and to operate a computer. Must be able to read, write, and speak English. May need to lift up to 25 pounds. Possible exposure to bodily fluids in a medical clinic setting. TRAVEL: Travel required up to 75% of the time January June. Occasional travel required outside of audit season. Overnight stays possible. SUPERVISORY RESPONSIBILITY: This position has no supervisory responsibilities. OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.QualificationsPRINCIPAL DUTIES & RESPONSIBILITIES Support and maintain outreach initiatives and other quality improvement strategies Detailed technical understanding of HEDIS, CAHPS, HOS, and Meaningful Use measures set by CMS performance standards Answers questions and provides clear instructions to enhance patient compliance and support quality metrics Maintains and reviews medical records for purposes of identifying, confirming, and/or documenting referrals, results and appropriate medical coding Scans and indexes documents to patient charts as needed Adhere to company and department policies and procedures Maintains appropriate certification and/or license as required for this position Other duties as assigned   EDUCATION AND EXPERIENCE: High School diploma or equivalent required Current Certified/Registered Medical Assistant in State of Oklahoma or six months of experience with a health plan or within a quality department or clinical setting required. Valid state Drivers License, reliable personal vehicle and proof of personal vehicle liability insurance required.   KNOWLEDGE, SKILLS & ABILITIES Certified/Registered Medical Assistant in State of Oklahoma or will consider 3 years of experience with a health plan, Quality Department or clinical setting Ability to communicate and manage complex working relationships Strong organizational, verbal, time management, and telephone skills Computer literate and familiar with Microsoft applications (Word, Excel) Basic electronic health record knowledge and ability to quickly learn new software Detailed knowledge of quality performance measures and clinical health care Must have valid Oklahoma drivers license and able to drive a car.     WORKING CONDITIONS: Prolonged sitting at a desk using telephone and computer. Frequent and repetitive keyboard use.  Work involves standing and walking for brief periods of time. Work requires normal vision and hearing as might be required in typical conversation use and to operate a computer. Must be able to read, write, and speak English.  May need to lift up to 25 pounds. Possible exposure to bodily fluids in a medical clinic setting.   TRAVEL:  Travel required up to 75% of the time January June. Occasional travel required outside of audit season. Overnight stays possible.   SUPERVISORY RESPONSIBILITY: This position has no supervisory responsibilities.   OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.