Clinical Quality Specialist
SIHO Insurance Services•Columbus, IN
About The Position
The Clinical Quality Specialist supports the Clinical Quality Nurse in overseeing HEDIS quality collection, submission, reporting, and auditing, and assists with education supporting the MyTruAdvantage line of business. The role helps coordinate clinical data collection with health partners and provider offices, supports medical record review and audit processes, and contributes to quality improvement initiatives for Medicare Advantage or commercial lines of business.
Requirements
- Proficiency in Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint.
- Experience with electronic medical records and online tools.
- Ability to communicate professionally with physicians and office staff to facilitate organizational initiatives.
- Willingness to obtain HEDIS certifications applicable to the position.
Nice To Haves
- CMA certification or experience in clinical documentation review.
- Experience working for or with HEDIS data collection and reporting.
Responsibilities
- Apply knowledge of current HEDIS guidance, hybrid measure reporting, and measure compliance requirements.
- Collaborate with the Clinical Quality Nurse and internal data analyst to oversee distribution of HEDIS quality gaps to health partners and member providers for clinical data collection.
- Communicate with health partners about clinical document submission processes, annual education on applicable HEDIS measures, and reporting cadence.
- Help identify opportunities to improve or expand HEDIS data collection.
- Participate in internal chart-chasing efforts.
- Ensure proper internal secure storage of HEDIS data collected from external providers.
- Participate in Medical Record Review clinical submission processes, ensuring accuracy and completeness.
- Support outreach to external providers to collect clinical records needed for reporting.
- Help maintain HEDIS-related guidelines, policies and procedures, and auditing documents necessary for annual HEDIS audits.
- Participate in external HEDIS audits as needed.
- Support internal Chronic Care Improvement Program initiatives as needed.
- Participate in internal or external process improvement efforts supporting quality improvement and collection for Medicare Advantage or commercial lines of business, including provider attribution and training health partners and new internal staff.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
