As the Commercial Quality Specialist, this individual will be responsible for ensuring positive HEDIS quality performance outcomes in accordance with the expectations of each partnered insurance payor. Tasks can range from researching best practices that can help improve quality performance to providing direct support to practices who underperform in quality. This position is ideal for candidates who enjoy conducting research, creating training materials, and work as a team to improve performance outcomes.
- Research best practices and create educational materials for our physicians to increase quality outcomes.
- Coordinate initiatives in accordance with the most significant need based on data provided.
- Notify manager of areas of opportunities and suggest solutions to improve quality results.
- Oversee quality attestation initiatives daily and adjust priorities as needed.
- Monitor rate of completion and consistently reach 85% of the set goal.
- Navigate through various Electronic Medical Records (EMR) to obtain appropriate documentation of quality measure completion based on specified guidelines.
- Meet predesignated attestation collection goals on a weekly and monthly basis.
- Conduct 30+ chart reviews daily and determine whether evaluated providers are abiding by proper documentation standards. Engage and educate providers who are not meeting designated standards.
- Monitor strategies / toolsets for more accurate and efficient engagement of physician members and office staff.
- Adopt technological skills necessary to remotely integrate Annual Physical templates within practice EMRs.
- Submit file /documentation to physicians and other clinicians as requested for reviewing, quality assurance checks, and other purposes.
- Abide by all HIPAA, Confidentiality and Privacy laws.
- Conduct research, collect and analyze data to prepare reports and documents.
- File and retrieve documents and reference materials.
- Assist in maintaining area organized, clean.
- Other job related duties.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
Must have a minimum or pursuit of AA / Bachelor’s degree; or One-year related experience and/or training preferable; or equivalent combination of education and experience. 1-2 years’ experience working with major EMR software. (eClinical, Athena, PracticeFusion, etc.)
Language Skills:
Ability to read and comprehend simple instructions, correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one situations to visitors, clients, and other employees of the organization.
Computer Skills:
MS Office Productivity Tools (Word, Excel, Outlook, PowerPoint)
Other Skills and Abilities:
High accuracy and extreme confidentiality a MUST. Detail oriented and very organized. Ability to alphabetize and put information (materials, forms, etc.) into chronological order. Analyze medical records for completeness, schedule time and assignment effectively.
Physical Demands:
While performing the duties of this Job, the employee will have a combination of standing, sitting, bending and reaching. May work at a computer monitors for prolonged periods. The employee may lift and/or move up to 10 pounds. The position may require driving for minimal periods of time, as well as walking to and from provider offices potentially up and down stairs.