HEDIS Quality Analyst

Southern Indian Health Council, Inc•Alpine, CA

8h•$27 - $39•Onsite

About The Position

This position serves to integrate ongoing quality health information measures to ensure continuous quality improvement. This position supports clinical software applications used for and with the Electronic Health Record (EHR). This position supports healthcare metric reporting geared towards developing organizational quality improvement methods. This position will regularly consult with Department Directors for on-going and review of workflow processes in daily operations to improve patient care and experience. The overall goal of this position is to collect and review healthcare metrics and coordinate with employees to develop activities to enhance the quality of care for patients while simultaneously enhancing performance measures.

Requirements

Experience in performance improvement, project management, healthcare analytics, and quality metric reporting in a public or private healthcare facility required.
Electronic Health Record database experience required.
A valid driver’s license is required and must be maintained throughout employment.
Applicant must be able to travel throughout the organization’s service area including all SIHC site locations.
Current certifications and/or licenses appropriate to the positions required education and profession.
Applicants must have a reputation for honesty and trustworthiness.
Must be responsible and able to exercise good judgment, accept administrative supervision, pay attention to detail, follow instructions, including the ability to interact effectively and communicate with people in a professional and courteous manner.
Must be highly confidential and work as a team with other staff.
Applicants should be sensitive to client’s needs.
Strong team building, interpersonal, and organizational skills.
Ability to establish and maintain effective peer relationships with coworkers within the Department, clinic-wide, and the public.
Must be able to express ideas clearly, concisely, address audiences effectively, and exercise balanced judgment in evaluating situations and making decisions.
Willing to be part of a team and cooperate in accomplishing department goals and objectives.
Ability to prioritize, meet deadlines, take initiative, be proactive, and function in a rapidly changing environment.
Ability to work with people of all social and ethnic backgrounds, resolves conflicts, negotiates situations, and facilitates consensus.
Normal clinic/office environment.
Sit or stand for long periods of time.
Reach, bend, climb, stoop, lift up to 25 lbs.
repetitive hand movement; use and view PC.
Reliable transportation and car insurance as required by the state.
Travel as needed.
Each employee plays a key role in creating a compliance culture at SIHC.
Employees are expected to learn and comply with all SIHC policies and procedures.
One must have the ability to understand the implications and complexities of all compliance policies.
Participation in all compliance training is mandatory, and generally has a heightened awareness of policies and regulations that are specific to one’s department and position.
All SIHC employees are expected to report violations or suspected violations of compliance policies or regulations.
Applicants must successfully pass a pre-screening tuberculin skin test or x-ray and a blood/urine drug screening test.
Health must be adequate to perform all duties of the position.
Applicants must complete SIHC Application and Authorization Form, both must be submitted to Human Resources prior to the close date indicated.

Nice To Haves

A bachelor’s degree in a healthcare related or database management field preferred.
Professional licensensure and/or certification in Medical Assistance, or Nursing field is a plus.

Responsibilities

Review daily schedule of medical, dental, and mental wellness patients scheduled to identify missing “measures” to support a patient centered care approach.
Capture of clinical encounter information by running reports and providing outcomes to employees and enacting plans to improve patient care as reflected in healthcare metrics.
Serves as the organizational lead for HEDIS operations, including measure monitoring, gap closure strategies, supplemental data submissions, payer collaboration, provider education, and performance improvement activities.
Maintains and monitors quality measure dashboards, scorecards, provider performance reports, and organizational performance metrics to support quality improvement activities.
Compiles, analyzes, updates, and distributes quality metric reports, dashboards, scorecards, and performance updates to leadership, providers, departments, and external stakeholders as needed.
Promotes an awareness of the importance of data validity and data security.
Identifies workflow deficiencies impacting quality measure capture and collaborates with operational clinical and IT teams to design and implement corrective actions.
Coordinates efforts to correct deficiencies and errors that occur in the EHR.
Identifying workflow deficiencies.
Investigating missed metrics.
Building corrective action plans.
Coordinating with IT and NextGen support.
Develops and delivers quality measure education and training programs, including HEDIS, GPRA, provider onboarding, annual refreshers, and department-specific training.
Analyzes and evaluates processes related to information flow.
Acquires a comprehensive knowledge of the software involved to determine procedural issues versus system/application deficiencies.
Serves as subject matter expert and administrator for quality measure and population health technologies utilized to capture, monitor, and report healthcare metrics.
Establishes effective interpersonal relationships with all levels of SIHC support personnel.
Serves as a cross-functional resource supporting quality initiatives across all departments to improve organizational performance and patient outcomes.
Develops and distributes provider, department, and organizational performance reports and dashboards related to HEDIS, GPRA, and other quality measures.
Promotes an atmosphere that encourages enthusiasm and user participation in clinical computing.
Creates a positive environment for reporting application and/or system deficiencies and suggestions for system improvements and enhanced functionality.
Coordinates health metrics performance improvement activities routinely.
Coordinates quality improvement initiatives and performance improvement projects designed to improve clinical outcomes and quality measure performance.
Provides requested data reports to approved organizations, such as those conducted by the Health Center Partners and Indian Health Services.
Conducts ongoing chart audits, scheduled patient reviews, chart reviews, documentation correction activities, and maintenance of care guidelines and health maintenance records to ensure accurate quality measure capture and reporting.
Chart audits.
Review of scheduled patients.
Retrospective chart reviews.
Documentation corrections for HEDIS/GPRA measures.
Daily Metric Maintenance in Patient Charts
review and maintenance of patient charts, care guidelines, health maintenance records, and clinical documentation to ensure accurate quality measure capture and reporting.
Provide time and talents as part of the Quality Management Team by conducting health care audits, participate in site visits and surveys.
Prepares reports for presentation to the Quality Management Meeting and the Board of Director’s Quality Committee meeting.
Complies with all SIHC policies & procedures.
Coordinates and conducts patient outreach activities including letters, telephone calls, text campaigns, and other communication methods to close care gaps and improve quality measure performance.
Creation and mailing of outreach letters.
Phone outreach to patients with care gaps.
Tracking outreach outcomes.
Scheduling support for quality measure appointments.
Population health campaigns (Well Child, Well Woman, Mammogram, Colon Cancer Screening, etc.).
Serves as the primary liaison between SIHC and health plans regarding quality metrics, supplemental data submissions, gap closure initiatives, incentive programs, and performance improvement activities.
Direct interaction with Insurance payers.
Coordinating payer meetings.
Reviewing payer-specific HEDIS metrics.
Addressing data discrepancies with health plans
Responsible for collection, validation, export, submission, and reconciliation of supplemental quality data to health plans, regulatory agencies, and external partners.
Exporting supplemental files.
Uploading data to payer portals.
Managing payer portal access.
Reconciling submitted data.
Coordinates grant-related quality activities including metric tracking, reporting requirements, implementation support, and collaboration with grant partners.
Plans, coordinates, and evaluates community outreach programs, screening events, and preventive health initiatives designed to improve quality measure outcomes.
Mammogram Bus.
Community screening events.
Preventive outreach programs
Coordinates quality-related community events and screening programs, including tracking patient results, collaborating with departments for follow-up care, and ensuring appropriate documentation and closure of identified care gaps.
Coordinates quality incentive programs, patient engagement incentives, and associated auditing and reporting activities.
Sharp incentive payouts.
Molina incentive payouts.
Assists the Quality Management Department with quality-related training, onboarding activities, and staff education as needed.
Develops, maintains, and updates Standard Operating Procedures (SOPs), workflows, job aids, and training materials for quality improvement initiatives, metric reporting processes, population health programs, grants, and new projects.
Other duties as assigned.