Quality Improvement Coordinator

CLAREMEDICA HEALTH PARTNERS LLC•Hialeah, FL

About The Position

At Claremedica, exceptional is the standard. Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives. That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At Claremedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities. Opportunity awaits – welcome to Claremedica. ESSENTIAL FUNCTIONS The Quality Improvement Coordinator performs evaluation of patient’s satisfaction, review of medical records and Health Plans Information to work on continuous Quality Improvement. The Quality Improvement (QI) Coordinator is responsible for the improvement of patient’s satisfaction with the organization services as well as the improvement of Quality of clinical care. His/Her tasks include the review and abstraction of data and information from Medical Records. The QI coordinator must review among others CPT code and category II codes for performance measurement facilitating data collection about Quality of Care rendered. Present quality performance information on gaps in care to providers and clinic administrators to improve quality outcomes such as HEDIS and other internal quality benchmarks. Work with patients to ensure their engagement and compliance with recommended tests or procedures.

Requirements

High school diploma or GED required
Minimum of 1 year of HEDIS/Quality experience in primary care organization and or specialist office, managed care organization preferred
Proficient in official coding guidelines, ICD-10CM, CPT-4 and HCPCS.
Working knowledge of Stars/HEDIS measures, CPT codes to bill activities and interventions needed to close gaps in care for HEDIS and Stars.
Collection and review of Medical Record when needed.
Proficient knowledge of computers and typical production software (e.g., MS Office, Outlook, Word, Excel, PowerPoint, etc.).
Effective communication skills
Experience and proficiency with different Electronic Medical Records
Position may require traveling throughout Florida, including and not limited to driving between site locations throughout Miami-Dade and Broward County locations.

Responsibilities

Coordinating and completing HEDIS Quality Improvement specific projects ensuring consistency with the company strategy, commitment, and goals.
Contacting patients to evaluate their satisfaction with the organization’s services.
Promoting and coordinating actions with other staff from Claremedica centers oriented to identify opportunities for improvement in patient’s satisfaction.
Reviewing Medical Records to collect HEDIS information if needed.
Appropriate use of organization EMR and/or HEDIS software (data entry, reporting)
Proactively identify opportunities for improvement, looking for existing issues or new problematic areas, trends, etc.
Prepares Quality/ HEDIS reports in an accurate, concise, and timely fashion.
Perform other related duties oriented to reach the organization’s Quality/HEDIS monthly and yearly goals.
Contact and educate patients to ensure better compliance with recommended behaviors
Proactively work and collaborate with clinical and administrative staff at the center.