Auditor, ACO Quality

Cano Health•Miami, FL

About The Position

It's rewarding to be on a team of people that truly believe in making an impact! We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us. Job Summary The ACO Quality Auditor is responsible for maintaining HEDIS/Stars Ratings across all payors. Support practices by providing quality improvement guidance, continuing training, reviews, and best practices for HEDIS/Stars Ratings. This candidate should have excellent communication skills and be able to act proactively to ensure smooth team operations and effective collaboration facilitating interdisciplinary approaches.

Requirements

Required: High school Diploma or higher education.
Fluency in English and Spanish is required to communicate effectively.
Required Certified Coder; CPC
Minimum two (2) years of related work experience.
Ability to communicate with employees, patients, and other individuals in a professional and courteous manner.
Bilingual (English & Spanish)
Ability to pay close attention to detail and to ensure accuracy of reports and data.
Skill in operating phones, personal computer, software, and other IT systems.
Must be a quick learner, who can demonstrate the ability to follow multi-step instructions, be a problem solver, and adhere to department protocols
Must be able to stand, sit, walk, and occasionally climb.
The incumbent must be able to work extended and flexible hours and weekends as needed.
Physical demands include ability to lift to 50 lbs.

Nice To Haves

Medical Assistant or Clinical Administrative Assistant experience.
Knowledge of Quality- HEDIS Measures

Responsibilities

Performs on-site and remote clinical validation audits and interpretation of medical documentation to capture all Quality Care Gaps.
Represent the Quality department with tracking open gaps to ensure HEDIS standards are meet as follow but not limited to: Part-D & Medication Adherence, Part-C & Preventive Care measures, Patient Experience and Audit Process.
Commit to training of office manager, medical assistant, medical technician, biller etc. on applying HEDIS best practices for gaps closure.
Responsible for distributing the HEDIS care gaps report by practice, review pending gaps and areas of opportunities and follow up as needed
Guide and suggest practices uniformity on the generalization on daily process where Quality data is collected.
Complete Care Gap audits and analyzes data to identify trends and improvement opportunities.
Other daily activities include the ability to manage large amounts of data electronically, extract and analyze data, file documents in electronic filing software, faxing, scanning, and abstracting documents from electronic storage devices
Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements.
Attend Meetings/Identify any gaps in process and create action plan.
Any other duties or responsibilities assigned