About the position
The Quality Operations Coordinator role is responsible for managing Quality operational support initiatives while overseeing special projects, with a focus on supporting HEDIS and Pharmacy gap closures. This position requires daily problem-solving, meticulous tracking, and coordination across departments to meet varying and changing requirements. The QOC will oversee assigned affiliate groups, providing Quality operational support to clinics to achieve their goals, which may include engaging with internal and external stakeholders with in-person and telephonic outreach to patients for education and engagement on preventative screenings, data mining, medication adherence, and follow-up with primary care providers. This position may directly interact with patients to complete tasks for quality gap closure. The Quality Operations Coordinator will support the assigned market under the direction of the market VP with the assistance of the National Quality Manager.
Responsibilities
- Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA
- Provides support to the Quality Management Department by working with members and network providers to improve quality of care through quality activities such as HEDIS, CMS Star Rating, and other quality performance reporting
- Provides telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or other opportunities for improvement of healthcare performance measure related issues
- Improves patient experience and transitions for better healthcare outcomes through quality care
- Participates in data collecting through medical record and claims surveillance
- Works to maximize health plan and healthcare provider performance on healthcare related quality measures through effective telehealth communication with patients and coordination with patient caregivers, providers, and pharmacies
- Assists in planning, implementing, and executing projects to improve quality and delivery of care services
- Using research and knowledge, identifies potential interventions to improve quality strategies
- Participates in Quality Management meetings and other initiatives
- Prepares quality information for presentation to affiliate groups, including groups current standings relative to others and opportunities or improvement
- Point of Contact for provider groups designated by leader
- Leads project management of Quality Fairs, Diabetic Days, and P3 events to maximize quality gap closure
- Subject Matter Expert in P3 machines (diabetic eye camera, bone density machine, etc.)
- Responds to health plan, provider and interdepartmental calls in accordance with exceptional customer service
- Reviews provider group gap uploads through the P3 Provider portal
- Other duties as assigned
Requirements
- High school diploma/GED required, associate degree in related field or equivalent experience preferred
- 2+ years experience in healthcare-related fields required, clinical health care related experience, managed care, or Health plan experience strongly preferred
- Experience with Microsoft Word, Excel, Power Point, Outlook and general office equipment such as copier, fax machine, required
- Experience in Electronic Health Records required
- Medical Assistant Certification or experience as a Pharmacy Tech, Radiology Tech, Lab Tech or similar strongly preferred
- Experience with data mining is preferred
- Medical terminology knowledge required, experience with CPT II codes preferred
