Clinical Operations Specialist

Spiras Health - Brentwood, TN

Full-time - Mid Level

Hybrid - Brentwood, TN

Ambulatory Health Care Services

About the position

The Quality Review Specialist at Spiras Health is a detail-oriented professional responsible for reviewing medical records and telephonic patient interactions. This role involves preparing audits, validating clinician licenses, and reviewing pending medical claims for errors. The position supports the Operations department and offers opportunities for skill development in a hybrid work environment.

Responsibilities

• Navigate EMR system to complete assigned duties
• Review charts and accurately document results
• Review patient encounters to confirm they meet contractual requirements
• Review pending claims for accuracy
• Track patients that leave Spiras Program
• Confirm insurance eligibility, if needed
• Assist the Director, Clinical Quality & Excellence with testing changes and upgrades to EMR
• Assist with preparedness for new contracts and setting Spiras up to do business in new states

Requirements

• Completion of a certificate or associate degree in a medical related field (CMA, LPN, RT)
• 2+ years of healthcare experience
• Exceptional verbal and written communication skills
• Strong decision-making skills
• Ability to adapt to the needs of the organization and colleagues
• Comfortable working within different software platforms (such as Outlook, Excel, Word, Teams)
• EMR Experience (eCW experience is a plus)
• Excellent organizational and time management skills

Benefits

• Health insurance