Spanish Bilingual Virtual QI-Medical Receptionist

This is a remote position.

• Monday to Friday 8 AM - 5 PM PST 
  

• Answer incoming calls, route messages, and manage ULTATEL TEXT Message systems professionally
  
• Schedule appointments, transportation, follow-up on GA food’s requested
  
• Provide courteous, bi-lingual communication to members and providers
  
• Maintain accurate documentation in SwyftOps systems and ensure timely data entry
  

• Track and report care gaps, HEDIS measures, and Chart Audits
  
• Support QI initiatives by assisting with chart audits, care plan reviews, and compliance checklists
  
• Communicate with providers and case managers to ensure documentation accuracy and care gaps are being addressed
  
• Assist with referrals, authorizations, and coordination of specialty services
  

• Understand BLEHEALTH’s Enhanced Care Management (ECM) model, including eligibility, referral workflows, and service offerings.
  
• Support member onboarding by explaining ECM benefits, care coordination goals, and available resources in both English and Spanish.
  
• Assist with Outreach & Referral (OR) processes, ensuring timely follow-up and accurate documentation of member engagement.
  
• Maintain working knowledge of Medi-Cal guidelines, CalAIM initiatives, and interdisciplinary care approach.
  
• Participate in ongoing training to stay current on program updates, compliance standards, and QI metrics.
  

• Maintain a secure, quiet, and ergonomically appropriate home office environment
  
• Log in daily via Teams by 8:15 AM (PST) and attend scheduled huddles or meetings
  
• Submit daily productivity reports and categorized schedules to supervisor by end of day (tracking report)
  
•  Ensure HIPAA-compliant handling of PHI—no public or shared spaces permitted
  
• Follow client's password and data security protocols, including locked storage and regular password updates
  
• Limit personal tasks to designated breaks and lunch periods
  

• High school diploma and Associate degree in Business Administration, Healthcare, or related field preferred<