CW Risk Adj & Clinical QA Specialist

Baton Rouge, LA 70801

Posted: 09/10/2018 Employment Type: Temporary Industry: Clerical Job Number: 00004MYF Pay Rate: 17.00
Spherion has an opening for a CW Risk Adjustment & Clinical Quality Retrieval Specialist.

This position is responsible for medical record chart retrieval between Blue Cross Blue Shield of Louisiana and medical services providers.
Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.

Position Location:
This position reports to the Director, Risk Optimization and Population Health Analysis.

Necessary Contacts:
In order to effectively fulfill this position the incumbent must be in contact with:
All levels of BCBSLA personnel; physicians and their office personnel; hospitals and allied health provider administration and personnel; other Blue Plans; BCBS Association and contracted vendors.

High School diploma or equivalent is required. Additional business or secretarial training is preferred.
One year of prior secretarial, administrative assistant, or other customer-facing experience is required. Medical service provider experience is preferred.
Must have excellent PC skills, including MS Word, Outlook PowerPoint, and advanced Excel.
Excellent verbal and written communication skills are required.
Understanding of medical coding, risk adjustment, and/or HEDIS/STARS is preferred.

Handles telephone, email, and fax communication with provider offices and vendors to retrieve medical records.
Documents conversations with provider offices and vendors, and tracks outcomes. Scans and tags medical records into document management system.
Queries and identifies relevant medical records within (but not limited to) document management system, care management system, and vendor(s) databases.
Attends departmental meetings and document action items.
May conduct research as directed by management.
Work to be performed on-site at the Bluebonnet Corporate headquarters.
Adherence to a schedule is required for this position to maintain productivity.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while sitting or standing.
The ability to comprehend, document, calculate, visualize, and analyze are required.

Apply with Spherion today or contact our office at 225-925-5686.


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