Quality Specialist

Mount Sinai Medical Center • Hialeah, FL

5d • Onsite

About The Position

The Quality Specialist supports the Wellness & Preventive Management (WPM) Program, focusing on HEDIS measures, Annual Wellness Visits (AWVs), and care gap closure. This role is responsible for reviewing medical records, abstracting clinical data, identifying missing quality measures, and collaborating with providers and clinic staff to improve performance and patient outcomes. Key responsibilities include managing quality reports, monitoring provider-level performance, requesting documentation from external sources, and ensuring accurate submission of HEDIS data to health plans. The Quality Specialist partners closely with leadership to execute quality improvement strategies and drive compliance with regulatory standards.

Requirements

• High School Diploma.

Nice To Haves

• Certified Medical Assistant or Registered Medical Assistant.
• Bachelor of Sciences degree or in other related field, foreign medical graduate
• One year of experience in Care Coordination in outpatient setting or HMO, MSO or ACO.

Responsibilities

• Responsible for supporting the Wellness & Preventative Management Program (WPM): HEDIS, Annual Wellness Visits, Appointments, and other Care Coordination tasks.
• Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g. results of laboratory tests, verification of hypertension and the most recent blood pressure reading.
• Collect medical record data and identify needed improvements that impact HEDIS measures.
• Review noncompliant reports and flags patient’s charts with the missing measures.
• Request quality data documentation from outside resources.
• Works closely with leadership to execute quality strategies.
• Manage the reports and monitors performance at group and providers level.
• Engages PCP and clinic staff in developing strategies to close quality gaps.
• Upload HEDIS data to medical records and send it to the health plan.
• Performs all other related duties as assigned

Benefits

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED