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Quality & Patient Specialist I
68AE5BDFC40BB34F7F0A6BE82D54ECC2 · Franklin, LA 70538; 1115 Weber St., Franklin, LA, 70538, USA · Active · Paycom ATS
Job facts
| Field | Value |
|---|---|
| Company | 68AE5BDFC40BB34F7F0A6BE82D54ECC2 |
| Title | Quality & Patient Specialist I |
| Normalized title | - |
| Department / team | - |
| Location | Franklin, LA, United States |
| Work model | - |
| Employment type | Full Time |
| Salary | - |
| Status | active |
| ATS provider | Paycom ATS |
| Posted / first seen | 2026-05-15 / 2026-05-31 |
| Changed / last seen | 2026-05-31 / 2026-06-06 |
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| Provider filtered search | The same provider as a filtered job collection. | Open |
| City jobs | Active postings in Franklin. | Open |
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Linked records
| Company | 68AE5BDFC40BB34F7F0A6BE82D54ECC2 |
| Source | 4fda89fa-e626-4954-bd8c-798b2f440931 |
| ATS provider | Paycom ATS |
Description
Quality & Patient Specialist I
Teche Health, A Federally Qualified Health Center, per Section 330 of the Public Health Service Act, is currently seeking qualified applicants for the Quality & Patient Specialist I position in Franklin, Louisiana.
JOB SUMMARY :
The Quality & Patient Specialist I is an integral part of the Quality & Clinical Risk Management Team. This position supports the development and maintenance of quality improvement efforts to achieve improved clinical outcomes and mitigate clinical risks. This position serves as the preceptor for staff responsible for Medication Prior Authorizations. This position performs heavy chart monitoring and auditing of medical records. Assists with maintaining organizational adherence to Joint Commission standards. They work closely with provider staff, clinical support staff, patients, and insurance carriers to ensure timely processing of documentation requests. Must have knowledge of, or the ability to develop skills to navigate internal and external patient electronic health record systems, RadMd©, and CoverMyMeds©. This position requires travel to all TAC facilities as assigned.
JOB DUTIES AND RESPONSIBILITIES:
Conduct internal quality control reviews and clinical audits as assigned by CHIO or designee according to Policy and Procedure.
Summarize findings and prepare report on findings.
Assists CHIO or designee in implementing key quality strategies, which may include initiation and management of provider and patient interventions, preparation of quality improvement compliance surveys/audits, performance measurement activities related to HEDIS, UDS and other quality metrics.
Assist with preparation for clinical audit requests of external stakeholders according to Policy and Procedure.
Assist in maintaining ongoing tracking and appropriate documentation on all audit requests and audit findings.
Assist in promoting clinical staff awareness of audit finding to improve clinical outcomes and patient safety.
Ensure complete and accurate patient demographic and current insurance information.
Assists in data collection, data entry and generation of reports in support of QI initiatives including but not limited to access and availability audits, HEDIS abstraction, EMR reviews, patient satisfaction studies, UDS audits and reports, additional internal and MCO/ ACO requests as assigned.
Support the development of quality improvement performance audit function processes and tools.
Contact insurance companies to ensure prior approval requirements are met as appropriate. Present necessary medical information such as history, diagnosis, and prognosis.
Assist CHIO or designee with preparation and ongoing compliance to Joint Commission standards including conducting tracer activities as assigned.
Establish and maintain relationships with internal and external stakeholders.
Maintain documentation of pending and completed audits.
Track findings of audits; maintain documentation of status for received medical records requests, including consult notes, following audits.
Conduct chart audits to ensure up-to-date documentation of all patient information.
Determine the need for pharmaceutical prior authorizations as assigned by supervisor.
Process pharmaceutical prior authorizations (PA) using the CoverMyMeds© database, when applicable, or calling by communicating directly with insurance carriers.
Track pending PAs for determination of status.
Ensure up-to-date documentation of all patient’s prior authorization request.
Communicate with the provider regarding determination status, required documentation needed according to insurance guidelines.
Answer phone calls from patients, pharmacies, and insurance carriers using exemplary customer service skills.
Review structured clinical data matching it against specific medical terms and diagnoses.
Assemble information concerning patient's clinical background and prior approval needs, provider appropriate clinical information for further review.
Receive requests for records from insurance carriers specific to PA and ensure all requested records are sent in a timely manner and in compliance with HIP AA regulations.
Maintain patient confidentiality as defined by state, federal, and TAC requirements.
Greet patients, caregivers, and staff in a timely and pleasant manner.
Project a congenial and sensitive attitude toward patients, caregivers, and staff.
Exhibit a willingness to resolve problems and inefficiencies.
Provide consistent, timely and friendly service to both external and internal customers.
Actively support departmental and organizational strategic plans.
Actively support departmental and organizational quality assurance and performance improvement initiatives.
Performs other duties as assigned which are consistent with the position and in compliance with the organizations policy and procedure.
Performs other duties as assigned by Assistant Director of Quality & Clinical Risk Mgt, CHIO & CEO which are consistent with the position and in compliance with the organizations policy and procedure.
QUALIFICATIONS :
To perform this job successfully, an individual must be able to perform each duty described above satisfactorily. The following requirements are representative of the knowledge, skill and/or ability required for this job.
Education/Experience:
High School Diploma or equivalent and a minimum of 5 years in healthcare quality improvement / performance improvement.
Knowledge and experience in outpatient clinic setting and insurance prior authorization processes preferred.
Experience with electronic health records, CoverMyMeds© and RadMed© applications preferred.
Communication Ability:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
Must have interpersonal skills.
Ability to write routine reports and correspondences.
Ability to speak effectively with provider and clinical support staff, insurance carriers, and patients.
Math Ability:
Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's.
Ability to perform these operations using units of American money and weight measurement, volume and distance.
Reasoning Ability:
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.
Ability to work reliably and with professionalism in a high-volume, high-demand medical environment.
Computer Skills:
Proficiency in Microsoft Word, Microsoft Excel, and email.
Prefer skills in using EHR software.
Prefer skills in using referral EHR software, CoverMyMeds© and RadMD© applications.
Professional Skills:
High level of confidentiality required.
Ability to work independently and within a team.
Benefits Package:
Medical, Vision and Dental Health Insurance
Accidental Insurance
Critical Illness Insurance
Cancer Insurance
Hospital Indemnity Insurance
Long Term Benefits
Short Term Benefits
Free Life Insurance
401K Plan Benefits
Paid Vacation
Paid Sick Time
Set Schedule
National Health Service Corps Site
11 paid holidays
Family-Friendly Work Environment
Eligible for Student Loan Forgiveness through Federal and State Programs
Eligibility Requirements:
All employees must meet eligibility standards in order to be considered for the position applying for. Internal applicants must be with be with the organization for at least one year, with no disciplinary actions on file. If you have not been with the organization for a year, approval from your direct supervisor will be needed.
**Due to CMS Mandate all applicants must be fully vaccinated prior to onboarding with Teche Health with the exception of an approved Medical or Religious Exemption.**
Full job record
| Job ID | aabb3fead5105ca6f5cf950c4d668969a9ef7031 |
| Org ID | 2c372a22-0063-42e3-b799-9b443e9b50b3 |
| Source ID | 4fda89fa-e626-4954-bd8c-798b2f440931 |
| Board ID | 4fda89fa-e626-4954-bd8c-798b2f440931 |
| Provider | paycom |
| Provider Job Key | 32806 |
| Title | Quality & Patient Specialist I |
| Normalized Title | — |
| Status | active |
| Active | yes |
| Location Text | Franklin, LA 70538; 1115 Weber St., Franklin, LA, 70538, USA |
| Department | — |
| Team | — |
| Employment Type | full_time |
| Workplace Type | — |
| Remote Policy | — |
| Country | United States |
| Region | LA |
| City | Franklin |
| Salary Raw | Quality & Patient Specialist I Teche Health, A Federally Qualified Health Center, per Section 330 of the Public Health Service Act, is currently seeking qualified applicants for the Quality & Patient Specialist I position in Franklin, Louisiana. JOB SUMMARY : The Quality & Patient Specialist I is an integral part of the Quality & Clinical Risk Management Team. This position supports the development and maintenance of quality improvement efforts to achieve improved clinical outcomes and mitigate clinical risks. This position serves as the preceptor for staff responsible for Medication Prior Authorizations. This position performs heavy chart monitoring and auditing of medical records. Assists with maintaining organizational adherence to Joint Commission standards. They work closely with provider staff, clinical support staff, patients, and insurance carriers to ensure timely processing of documentation requests. Must have knowledge of, or the ability to develop skills to navigate internal and external patient electronic health record systems, RadMd©, and CoverMyMeds©. This position requires travel to all TAC facilities as assigned. JOB DUTIES AND RESPONSIBILITIES: Conduct internal quality control reviews and clinical audits as assigned by CHIO or designee according to Policy and Procedure. Summarize findings and prepare report on findings. Assists CHIO or designee in implementing key quality strategies, which may include initiation and management of provider and patient interventions, preparation of quality improvement compliance surveys/audits, performance measurement activities related to HEDIS, UDS and other quality metrics. Assist with preparation for clinical audit requests of external stakeholders according to Policy and Procedure. Assist in maintaining ongoing tracking and appropriate documentation on all audit requests and audit findings. Assist in promoting clinical staff awareness of audit finding to improve clinical outcomes and patient safety. Ensure complete and accurate patient demographic and current insurance information. Assists in data collection, data entry and generation of reports in support of QI initiatives including but not limited to access and availability audits, HEDIS abstraction, EMR reviews, patient satisfaction studies, UDS audits and reports, additional internal and MCO/ ACO requests as assigned. Support the development of quality improvement performance audit function processes and tools. Contact insurance companies to ensure prior approval requirements are met as appropriate. Present necessary medical information such as history, diagnosis, and prognosis. Assist CHIO or designee with preparation and ongoing compliance to Joint Commission standards including conducting tracer activities as assigned. Establish and maintain relationships with internal and external stakeholders. Maintain documentation of pending and completed audits. Track findings of audits; maintain documentation of status for received medical records requests, including consult notes, following audits. Conduct chart audits to ensure up-to-date documentation of all patient information. Determine the need for pharmaceutical prior authorizations as assigned by supervisor. Process pharmaceutical prior authorizations (PA) using the CoverMyMeds© database, when applicable, or calling by communicating directly with insurance carriers. Track pending PAs for determination of status. Ensure up-to-date documentation of all patient’s prior authorization request. Communicate with the provider regarding determination status, required documentation needed according to insurance guidelines. Answer phone calls from patients, pharmacies, and insurance carriers using exemplary customer service skills. Review structured clinical data matching it against specific medical terms and diagnoses. Assemble information concerning patient's clinical background and prior approval needs, provider appropriate clinical information for further review. Receive requests for records from insurance carriers specific to PA and ensure all requested records are sent in a timely manner and in compliance with HIP AA regulations. Maintain patient confidentiality as defined by state, federal, and TAC requirements. Greet patients, caregivers, and staff in a timely and pleasant manner. Project a congenial and sensitive attitude toward patients, caregivers, and staff. Exhibit a willingness to resolve problems and inefficiencies. Provide consistent, timely and friendly service to both external and internal customers. Actively support departmental and organizational strategic plans. Actively support departmental and organizational quality assurance and performance improvement initiatives. Performs other duties as assigned which are consistent with the position and in compliance with the organizations policy and procedure. Performs other duties as assigned by Assistant Director of Quality & Clinical Risk Mgt, CHIO & CEO which are consistent with the position and in compliance with the organizations policy and procedure. QUALIFICATIONS : To perform this job successfully, an individual must be able to perform each duty described above satisfactorily. The following requirements are representative of the knowledge, skill and/or ability required for this job. Education/Experience: High School Diploma or equivalent and a minimum of 5 years in healthcare quality improvement / performance improvement. Knowledge and experience in outpatient clinic setting and insurance prior authorization processes preferred. Experience with electronic health records, CoverMyMeds© and RadMed© applications preferred. Communication Ability: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Must have interpersonal skills. Ability to write routine reports and correspondences. Ability to speak effectively with provider and clinical support staff, insurance carriers, and patients. Math Ability: Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume and distance. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Ability to work reliably and with professionalism in a high-volume, high-demand medical environment. Computer Skills: Proficiency in Microsoft Word, Microsoft Excel, and email. Prefer skills in using EHR software. Prefer skills in using referral EHR software, CoverMyMeds© and RadMD© applications. Professional Skills: High level of confidentiality required. Ability to work independently and within a team. Benefits Package: Medical, Vision and Dental Health Insurance Accidental Insurance Critical Illness Insurance Cancer Insurance Hospital Indemnity Insurance Long Term Benefits Short Term Benefits Free Life Insurance 401K Plan Benefits Paid Vacation Paid Sick Time Set Schedule National Health Service Corps Site 11 paid holidays Family-Friendly Work Environment Eligible for Student Loan Forgiveness through Federal and State Programs Eligibility Requirements: All employees must meet eligibility standards in order to be considered for the position applying for. Internal applicants must be with be with the organization for at least one year, with no disciplinary actions on file. If you have not been with the organization for a year, approval from your direct supervisor will be needed. **Due to CMS Mandate all applicants must be fully vaccinated prior to onboarding with Teche Health with the exception of an approved Medical or Religious Exemption.** |
| Salary Min | — |
| Salary Max | — |
| Salary Currency | — |
| Salary Period | — |
| Source URL | https://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=32806&clientkey=68AE5BDFC40BB34F7F0A6BE82D54ECC2 |
| Apply URL | https://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=32806&clientkey=68AE5BDFC40BB34F7F0A6BE82D54ECC2 |
| First Seen At | 2026-05-31 19:06:07Z |
| Last Seen At | 2026-06-06 20:14:01Z |
| Last Checked At | 2026-06-06 20:14:01Z |
| Last Changed At | 2026-05-31 19:06:07Z |
| Inactive At | — |
| Source Posted At | 2026-05-15 00:00:00Z |
| Source Updated At | — |
| Raw Payload Uri | s3://job-postings-prod-raw-590183727216/raw/provider=paycom/board=68AE5BDFC40BB34F7F0A6BE82D54ECC2/date=2026-06-06/2026-06-06T20-13-59-040Z-141d93692239c0fa2fc82eb7ee43c842e0fc7403fad1a1f60fe56fafdecf07ca.json |
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"description": "<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>Teche Health, A Federally Qualified Health Center, per Section 330 of the Public Health Service Act, is currently seeking qualified applicants for the Quality & Patient Specialist I position in Franklin, Louisiana. </b></span></span></span></p>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>JOB SUMMARY</b>:</span></span></span></p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">The Quality & Patient Specialist I is an integral part of the Quality & Clinical Risk Management Team. This position supports the development and maintenance of quality improvement efforts to achieve improved clinical outcomes and mitigate clinical risks. This position serves as the preceptor for staff responsible for Medication Prior Authorizations. This position performs heavy chart monitoring and auditing of medical records. Assists with maintaining organizational adherence to Joint Commission standards. They work closely with provider staff, clinical support staff, patients, and insurance carriers to ensure timely processing of documentation requests. Must have knowledge of, or the ability to develop skills to navigate internal and external patient electronic health record systems, RadMd©, and CoverMyMeds©. This position requires travel to all TAC facilities as assigned. </span></span></span></p>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"> <b>JOB DUTIES AND RESPONSIBILITIES:</b></span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Conduct internal quality control reviews and clinical audits as assigned by CHIO or designee according to Policy and Procedure.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Summarize findings and prepare report on findings.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Assists CHIO or designee in implementing key quality strategies, which may include initiation and management of provider and patient interventions, preparation of quality improvement compliance surveys/audits, performance measurement activities related to HEDIS, UDS and other quality metrics.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Assist with preparation for clinical audit requests of external stakeholders according to Policy and Procedure.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Assist in maintaining ongoing tracking and appropriate documentation on all audit requests and audit findings.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Assist in promoting clinical staff awareness of audit finding to improve clinical outcomes and patient safety.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ensure complete and accurate patient demographic and current insurance information.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Assists in data collection, data entry and generation of reports in support of QI initiatives including but not limited to access and availability audits, HEDIS abstraction, EMR reviews, patient satisfaction studies, UDS audits and reports, additional internal and MCO/ ACO requests as assigned.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Support the development of quality improvement performance audit function processes and tools.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Contact insurance companies to ensure prior approval requirements are met as appropriate. Present necessary medical information such as history, diagnosis, and prognosis.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Assist CHIO or designee with preparation and ongoing compliance to Joint Commission standards including conducting tracer activities as assigned.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Establish and maintain relationships with internal and external stakeholders.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Maintain documentation of pending and completed audits.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Track findings of audits; maintain documentation of status for received medical records requests, including consult notes, following audits.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Conduct chart audits to ensure up-to-date documentation of all patient information.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Determine the need for pharmaceutical prior authorizations as assigned by supervisor. </span></span></span></span></li>\r\n</ul>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Process pharmaceutical prior authorizations (PA) using the CoverMyMeds© database, when applicable, or calling by communicating directly with insurance carriers.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Track pending PAs for determination of status.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ensure up-to-date documentation of all patient’s prior authorization request.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Communicate with the provider regarding determination status, required documentation needed according to insurance guidelines.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Answer phone calls from patients, pharmacies, and insurance carriers using exemplary customer service skills.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Review structured clinical data matching it against specific medical terms and diagnoses.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Assemble information concerning patient's clinical background and prior approval needs, provider appropriate clinical information for further review.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Receive requests for records from insurance carriers specific to PA and ensure all requested records are sent in a timely manner and in compliance with HIP AA regulations.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Maintain patient confidentiality as defined by state, federal, and TAC requirements.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Greet patients, caregivers, and staff in a timely and pleasant manner.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Project a congenial and sensitive attitude toward patients, caregivers, and staff.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Exhibit a willingness to resolve problems and inefficiencies.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Provide consistent, timely and friendly service to both external and internal customers.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Actively support departmental and organizational strategic plans.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Actively support departmental and organizational quality assurance and performance improvement initiatives.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Performs other duties as assigned which are consistent with the position and in compliance with the organizations policy and procedure.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Performs other duties as assigned by Assistant Director of Quality & Clinical Risk Mgt, CHIO & CEO which are consistent with the position and in compliance with the organizations policy and procedure.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>QUALIFICATIONS</b>:</span></span></span></p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">To perform this job successfully, an individual must be able to perform each duty described above satisfactorily. The following requirements are representative of the knowledge, skill and/or ability required for this job.</span></span></span></p>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>Education/Experience:</b> </span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">High School Diploma or equivalent and a minimum of 5 years in healthcare quality improvement / performance improvement.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Knowledge and experience in outpatient clinic setting and insurance prior authorization processes preferred.</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Experience with electronic health records, CoverMyMeds© and RadMed© applications preferred.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>Communication Ability: </b></span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Must have interpersonal skills. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to write routine reports and correspondences. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to speak effectively with provider and clinical support staff, insurance carriers, and patients.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>Math Ability: </b></span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to perform these operations using units of American money and weight measurement, volume and distance.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>Reasoning Ability:</b> </span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to work reliably and with professionalism in a high-volume, high-demand medical environment.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>Computer Skills:</b> </span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Proficiency in Microsoft Word, Microsoft Excel, and email. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Prefer skills in using EHR software. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Prefer skills in using referral EHR software, CoverMyMeds© and RadMD© applications.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"><b>Professional Skills:</b> </span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">High level of confidentiality required. </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Ability to work independently and within a team.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Benefits Package:</span></span></span></p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Medical, Vision and Dental Health Insurance</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Accidental Insurance</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Critical Illness Insurance</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Cancer Insurance</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Hospital Indemnity Insurance</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Long Term Benefits </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Short Term Benefits</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Free Life Insurance</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">401K Plan Benefits </span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Paid Vacation</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Paid Sick Time</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Set Schedule</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">National Health Service Corps Site</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">11 paid holidays</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Family-Friendly Work Environment</span></span></span></span></li>\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Eligible for Student Loan Forgiveness through Federal and State Programs</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">Eligibility Requirements:</span></span></span></p>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<ul style=\"margin-bottom:11px\">\r\n\t<li style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"tab-stops:list .5in\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\">All employees must meet eligibility standards in order to be considered for the position applying for. Internal applicants must be with be with the organization for at least one year, with no disciplinary actions on file. If you have not been with the organization for a year, approval from your direct supervisor will be needed.</span></span></span></span></li>\r\n</ul>\r\n\r\n<p style=\"margin-bottom:11px\"> </p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"font-family:Aptos,sans-serif\"> <b>**Due to CMS Mandate all applicants must be fully vaccinated prior to onboarding with Teche Health with the exception of an approved Medical or Religious Exemption.**</b></span></span></span></p>\r\n",
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"googleJobJson": "{\"@context\":\"https://schema.org/\",\"@type\":\"JobPosting\",\"title\":\"Quality & Patient Specialist I\",\"identifier\":\"J19B9532806\",\"url\":\"https://www.paycomonline.net/v4/ats/web.php/portal/68AE5BDFC40BB34F7F0A6BE82D54ECC2/jobs/32806\",\"image\":\"https://www.paycomonline.net/v4/ats/web.php/application/style/logo?clientkey=68AE5BDFC40BB34F7F0A6BE82D54ECC2\",\"datePosted\":\"2026-05-15\",\"description\":\"Job DetailsLevel: EntryJob Location: Franklin, LA 70538Position Type: Full TimeTeche Health, A Federally Qualified Health Center, per Section 330 of the Public Health Service Act, is currently seeking qualified applicants for the Quality & Patient Specialist I position in Franklin, Louisiana. \\r\\n\\r\\n \\r\\n\\r\\nJOB SUMMARY:\\r\\n\\r\\nThe Quality & Patient Specialist I is an integral part of the Quality & Clinical Risk Management Team. This position supports the development and maintenance of quality improvement efforts to achieve improved clinical outcomes and mitigate clinical risks. This position serves as the preceptor for staff responsible for Medication Prior Authorizations. This position performs heavy chart monitoring and auditing of medical records. Assists with maintaining organizational adherence to Joint Commission standards. They work closely with provider staff, clinical support staff, patients, and insurance carriers to ensure timely processing of documentation requests. Must have knowledge of, or the ability to develop skills to navigate internal and external patient electronic health record systems, RadMd©, and CoverMyMeds©. This position requires travel to all TAC facilities as assigned. \\r\\n\\r\\n \\r\\n\\r\\n JOB DUTIES AND RESPONSIBILITIES:\\r\\n\\r\\n\\r\\n\\tConduct internal quality control reviews and clinical audits as assigned by CHIO or designee according to Policy and Procedure.\\r\\n\\tSummarize findings and prepare report on findings.\\r\\n\\tAssists CHIO or designee in implementing key quality strategies, which may include initiation and management of provider and patient interventions, preparation of quality improvement compliance surveys/audits, performance measurement activities related to HEDIS, UDS and other quality metrics.\\r\\n\\tAssist with preparation for clinical audit requests of external stakeholders according to Policy and Procedure.\\r\\n\\tAssist in maintaining ongoing tracking and appropriate documentation on all audit requests and audit findings.\\r\\n\\tAssist in promoting clinical staff awareness of audit finding to improve clinical outcomes and patient safety.\\r\\n\\tEnsure complete and accurate patient demographic and current insurance information.\\r\\n\\tAssists in data collection, data entry and generation of reports in support of QI initiatives including but not limited to access and availability audits, HEDIS abstraction, EMR reviews, patient satisfaction studies, UDS audits and reports, additional internal and MCO/ ACO requests as assigned.\\r\\n\\tSupport the development of quality improvement performance audit function processes and tools.\\r\\n\\tContact insurance companies to ensure prior approval requirements are met as appropriate. Present necessary medical information such as history, diagnosis, and prognosis.\\r\\n\\tAssist CHIO or designee with preparation and ongoing compliance to Joint Commission standards including conducting tracer activities as assigned.\\r\\n\\tEstablish and maintain relationships with internal and external stakeholders.\\r\\n\\tMaintain documentation of pending and completed audits.\\r\\n\\tTrack findings of audits; maintain documentation of status for received medical records requests, including consult notes, following audits.\\r\\n\\tConduct chart audits to ensure up-to-date documentation of all patient information.\\r\\n\\tDetermine the need for pharmaceutical prior authorizations as assigned by supervisor. \\r\\n\\r\\n\\r\\n\\r\\n\\tProcess pharmaceutical prior authorizations (PA) using the CoverMyMeds© database, when applicable, or calling by communicating directly with insurance carriers.\\r\\n\\tTrack pending PAs for determination of status.\\r\\n\\tEnsure up-to-date documentation of all patient’s prior authorization request.\\r\\n\\tCommunicate with the provider regarding determination status, required documentation needed according to insurance guidelines.\\r\\n\\tAnswer phone calls from patients, pharmacies, and insurance carriers using exemplary customer service skills.\\r\\n\\tReview structured clinical data matching it against specific medical terms and diagnoses.\\r\\n\\tAssemble information concerning patient's clinical background and prior approval needs, provider appropriate clinical information for further review.\\r\\n\\tReceive requests for records from insurance carriers specific to PA and ensure all requested records are sent in a timely manner and in compliance with HIP AA regulations.\\r\\n\\tMaintain patient confidentiality as defined by state, federal, and TAC requirements.\\r\\n\\tGreet patients, caregivers, and staff in a timely and pleasant manner.\\r\\n\\tProject a congenial and sensitive attitude toward patients, caregivers, and staff.\\r\\n\\tExhibit a willingness to resolve problems and inefficiencies.\\r\\n\\tProvide consistent, timely and friendly service to both external and internal customers.\\r\\n\\tActively support departmental and organizational strategic plans.\\r\\n\\tActively support departmental and organizational quality assurance and performance improvement initiatives.\\r\\n\\tPerforms other duties as assigned which are consistent with the position and in compliance with the organizations policy and procedure.\\r\\n\\tPerforms other duties as assigned by Assistant Director of Quality & Clinical Risk Mgt, CHIO & CEO which are consistent with the position and in compliance with the organizations policy and procedure.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nQUALIFICATIONS:\\r\\n\\r\\nTo perform this job successfully, an individual must be able to perform each duty described above satisfactorily. The following requirements are representative of the knowledge, skill and/or ability required for this job.\\r\\n\\r\\n \\r\\n\\r\\nEducation/Experience: \\r\\n\\r\\n\\r\\n\\tHigh School Diploma or equivalent and a minimum of 5 years in healthcare quality improvement / performance improvement.\\r\\n\\tKnowledge and experience in outpatient clinic setting and insurance prior authorization processes preferred.\\r\\n\\tExperience with electronic health records, CoverMyMeds© and RadMed© applications preferred.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nCommunication Ability: \\r\\n\\r\\n\\r\\n\\tAbility to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. \\r\\n\\tMust have interpersonal skills. \\r\\n\\tAbility to write routine reports and correspondences. \\r\\n\\tAbility to speak effectively with provider and clinical support staff, insurance carriers, and patients.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nMath Ability: \\r\\n\\r\\n\\r\\n\\tAbility to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. \\r\\n\\tAbility to perform these operations using units of American money and weight measurement, volume and distance.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nReasoning Ability: \\r\\n\\r\\n\\r\\n\\tAbility to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. \\r\\n\\tAbility to interpret a variety of instructions furnished in written, oral, diagram or schedule form. \\r\\n\\tAbility to work reliably and with professionalism in a high-volume, high-demand medical environment.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nComputer Skills: \\r\\n\\r\\n\\r\\n\\tProficiency in Microsoft Word, Microsoft Excel, and email. \\r\\n\\tPrefer skills in using EHR software. \\r\\n\\tPrefer skills in using referral EHR software, CoverMyMeds© and RadMD© applications.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nProfessional Skills: \\r\\n\\r\\n\\r\\n\\tHigh level of confidentiality required. \\r\\n\\tAbility to work independently and within a team.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nBenefits Package:\\r\\n\\r\\n\\r\\n\\tMedical, Vision and Dental Health Insurance\\r\\n\\tAccidental Insurance\\r\\n\\tCritical Illness Insurance\\r\\n\\tCancer Insurance\\r\\n\\tHospital Indemnity Insurance\\r\\n\\tLong Term Benefits \\r\\n\\tShort Term Benefits\\r\\n\\tFree Life Insurance\\r\\n\\t401K Plan Benefits \\r\\n\\tPaid Vacation\\r\\n\\tPaid Sick Time\\r\\n\\tSet Schedule\\r\\n\\tNational Health Service Corps Site\\r\\n\\t11 paid holidays\\r\\n\\tFamily-Friendly Work Environment\\r\\n\\tEligible for Student Loan Forgiveness through Federal and State Programs\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nEligibility Requirements:\\r\\n\\r\\n \\r\\n\\r\\n\\r\\n\\tAll employees must meet eligibility standards in order to be considered for the position applying for. Internal applicants must be with be with the organization for at least one year, with no disciplinary actions on file. If you have not been with the organization for a year, approval from your direct supervisor will be needed.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\n **Due to CMS Mandate all applicants must be fully vaccinated prior to onboarding with Teche Health with the exception of an approved Medical or Religious Exemption.**\\r\\nQualifications\",\"responsibilities\":\"Teche Health, A Federally Qualified Health Center, per Section 330 of the Public Health Service Act, is currently seeking qualified applicants for the Quality & Patient Specialist I position in Franklin, Louisiana. \\r\\n\\r\\n \\r\\n\\r\\nJOB SUMMARY:\\r\\n\\r\\nThe Quality & Patient Specialist I is an integral part of the Quality & Clinical Risk Management Team. This position supports the development and maintenance of quality improvement efforts to achieve improved clinical outcomes and mitigate clinical risks. This position serves as the preceptor for staff responsible for Medication Prior Authorizations. This position performs heavy chart monitoring and auditing of medical records. Assists with maintaining organizational adherence to Joint Commission standards. They work closely with provider staff, clinical support staff, patients, and insurance carriers to ensure timely processing of documentation requests. Must have knowledge of, or the ability to develop skills to navigate internal and external patient electronic health record systems, RadMd©, and CoverMyMeds©. This position requires travel to all TAC facilities as assigned. \\r\\n\\r\\n \\r\\n\\r\\n JOB DUTIES AND RESPONSIBILITIES:\\r\\n\\r\\n\\r\\n\\tConduct internal quality control reviews and clinical audits as assigned by CHIO or designee according to Policy and Procedure.\\r\\n\\tSummarize findings and prepare report on findings.\\r\\n\\tAssists CHIO or designee in implementing key quality strategies, which may include initiation and management of provider and patient interventions, preparation of quality improvement compliance surveys/audits, performance measurement activities related to HEDIS, UDS and other quality metrics.\\r\\n\\tAssist with preparation for clinical audit requests of external stakeholders according to Policy and Procedure.\\r\\n\\tAssist in maintaining ongoing tracking and appropriate documentation on all audit requests and audit findings.\\r\\n\\tAssist in promoting clinical staff awareness of audit finding to improve clinical outcomes and patient safety.\\r\\n\\tEnsure complete and accurate patient demographic and current insurance information.\\r\\n\\tAssists in data collection, data entry and generation of reports in support of QI initiatives including but not limited to access and availability audits, HEDIS abstraction, EMR reviews, patient satisfaction studies, UDS audits and reports, additional internal and MCO/ ACO requests as assigned.\\r\\n\\tSupport the development of quality improvement performance audit function processes and tools.\\r\\n\\tContact insurance companies to ensure prior approval requirements are met as appropriate. Present necessary medical information such as history, diagnosis, and prognosis.\\r\\n\\tAssist CHIO or designee with preparation and ongoing compliance to Joint Commission standards including conducting tracer activities as assigned.\\r\\n\\tEstablish and maintain relationships with internal and external stakeholders.\\r\\n\\tMaintain documentation of pending and completed audits.\\r\\n\\tTrack findings of audits; maintain documentation of status for received medical records requests, including consult notes, following audits.\\r\\n\\tConduct chart audits to ensure up-to-date documentation of all patient information.\\r\\n\\tDetermine the need for pharmaceutical prior authorizations as assigned by supervisor. \\r\\n\\r\\n\\r\\n\\r\\n\\tProcess pharmaceutical prior authorizations (PA) using the CoverMyMeds© database, when applicable, or calling by communicating directly with insurance carriers.\\r\\n\\tTrack pending PAs for determination of status.\\r\\n\\tEnsure up-to-date documentation of all patient’s prior authorization request.\\r\\n\\tCommunicate with the provider regarding determination status, required documentation needed according to insurance guidelines.\\r\\n\\tAnswer phone calls from patients, pharmacies, and insurance carriers using exemplary customer service skills.\\r\\n\\tReview structured clinical data matching it against specific medical terms and diagnoses.\\r\\n\\tAssemble information concerning patient's clinical background and prior approval needs, provider appropriate clinical information for further review.\\r\\n\\tReceive requests for records from insurance carriers specific to PA and ensure all requested records are sent in a timely manner and in compliance with HIP AA regulations.\\r\\n\\tMaintain patient confidentiality as defined by state, federal, and TAC requirements.\\r\\n\\tGreet patients, caregivers, and staff in a timely and pleasant manner.\\r\\n\\tProject a congenial and sensitive attitude toward patients, caregivers, and staff.\\r\\n\\tExhibit a willingness to resolve problems and inefficiencies.\\r\\n\\tProvide consistent, timely and friendly service to both external and internal customers.\\r\\n\\tActively support departmental and organizational strategic plans.\\r\\n\\tActively support departmental and organizational quality assurance and performance improvement initiatives.\\r\\n\\tPerforms other duties as assigned which are consistent with the position and in compliance with the organizations policy and procedure.\\r\\n\\tPerforms other duties as assigned by Assistant Director of Quality & Clinical Risk Mgt, CHIO & CEO which are consistent with the position and in compliance with the organizations policy and procedure.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nQUALIFICATIONS:\\r\\n\\r\\nTo perform this job successfully, an individual must be able to perform each duty described above satisfactorily. The following requirements are representative of the knowledge, skill and/or ability required for this job.\\r\\n\\r\\n \\r\\n\\r\\nEducation/Experience: \\r\\n\\r\\n\\r\\n\\tHigh School Diploma or equivalent and a minimum of 5 years in healthcare quality improvement / performance improvement.\\r\\n\\tKnowledge and experience in outpatient clinic setting and insurance prior authorization processes preferred.\\r\\n\\tExperience with electronic health records, CoverMyMeds© and RadMed© applications preferred.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nCommunication Ability: \\r\\n\\r\\n\\r\\n\\tAbility to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. \\r\\n\\tMust have interpersonal skills. \\r\\n\\tAbility to write routine reports and correspondences. \\r\\n\\tAbility to speak effectively with provider and clinical support staff, insurance carriers, and patients.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nMath Ability: \\r\\n\\r\\n\\r\\n\\tAbility to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. \\r\\n\\tAbility to perform these operations using units of American money and weight measurement, volume and distance.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nReasoning Ability: \\r\\n\\r\\n\\r\\n\\tAbility to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. \\r\\n\\tAbility to interpret a variety of instructions furnished in written, oral, diagram or schedule form. \\r\\n\\tAbility to work reliably and with professionalism in a high-volume, high-demand medical environment.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nComputer Skills: \\r\\n\\r\\n\\r\\n\\tProficiency in Microsoft Word, Microsoft Excel, and email. \\r\\n\\tPrefer skills in using EHR software. \\r\\n\\tPrefer skills in using referral EHR software, CoverMyMeds© and RadMD© applications.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nProfessional Skills: \\r\\n\\r\\n\\r\\n\\tHigh level of confidentiality required. \\r\\n\\tAbility to work independently and within a team.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nBenefits Package:\\r\\n\\r\\n\\r\\n\\tMedical, Vision and Dental Health Insurance\\r\\n\\tAccidental Insurance\\r\\n\\tCritical Illness Insurance\\r\\n\\tCancer Insurance\\r\\n\\tHospital Indemnity Insurance\\r\\n\\tLong Term Benefits \\r\\n\\tShort Term Benefits\\r\\n\\tFree Life Insurance\\r\\n\\t401K Plan Benefits \\r\\n\\tPaid Vacation\\r\\n\\tPaid Sick Time\\r\\n\\tSet Schedule\\r\\n\\tNational Health Service Corps Site\\r\\n\\t11 paid holidays\\r\\n\\tFamily-Friendly Work Environment\\r\\n\\tEligible for Student Loan Forgiveness through Federal and State Programs\\r\\n\\r\\n\\r\\n \\r\\n\\r\\nEligibility Requirements:\\r\\n\\r\\n \\r\\n\\r\\n\\r\\n\\tAll employees must meet eligibility standards in order to be considered for the position applying for. Internal applicants must be with be with the organization for at least one year, with no disciplinary actions on file. If you have not been with the organization for a year, approval from your direct supervisor will be needed.\\r\\n\\r\\n\\r\\n \\r\\n\\r\\n **Due to CMS Mandate all applicants must be fully vaccinated prior to onboarding with Teche Health with the exception of an approved Medical or Religious Exemption.**\\r\\n\",\"employmentType\":\"FULL_TIME\",\"hiringOrganization\":{\"@type\":\"Organization\",\"name\":\"TECHE ACTION BOARD INC\",\"logo\":\"https://www.paycomonline.net/v4/ats/web.php/application/style/logo?clientkey=68AE5BDFC40BB34F7F0A6BE82D54ECC2\"},\"jobLocation\":{\"@type\":\"Place\",\"address\":{\"streetAddress\":\"1115 Weber St. \",\"addressLocality\":\"Franklin\",\"addressRegion\":\"LA\",\"postalCode\":70538,\"addressCountry\":\"USA\"}},\"validThrough\":\"-0001-11-30\"}",
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