Clinical Quality Coordinator-Hybrid Orlando Market
About The Position
This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records while maintaining a small group membership. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Requirements
- High School diploma or GED
- 3+ years of healthcare experience to include experience in a managed care setting
- 3+ years of experience with data analysis/quality chart reviews Must be able to review data and provide recommendations for improvement
- Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
Nice To Haves
- 2+ years of experience working with HEDIS/STAR measures
- 2+ years of college, in pursuance of a bachelor's or associate degree
- Experience or participation with similar regulatory reporting
- ICD 10/11 and CPT coding experience
- Experience working in a physician, provider, and/or medical office
- EMR and HEDIS knowledge and experience
Responsibilities
- Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff
- Review medical records for data collection, data entry, and quality monitoring including health plan/WellMed form submission and chart collection activities that close gaps in care
- Partner with the leadership team, to support data mining with a focus on group, large practice, targeted and special projects
- Communicate scheduling challenges or trends that may negatively impact quality outcomes
- Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments, lack of follow up on referrals, or inconsistent billing practices
- Activities may include data collection, data entry, quality monitoring, health plan/WellMed form submission and chart collection activities
- Assists with local IRR audits
- Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
- Support chart chase process by requesting records from provider’s offices as needed
- Maintains education/knowledge base of HEDIS/STARs
- Performs all other related duties as assigned
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
