Quality Specialist
About The Position
The Quality Specialist supports the Wellness & Preventative Management Program (WPM), including HEDIS, Annual Wellness Visits, appointments, and other care coordination tasks. The role reviews assigned medical records and abstracts clinical data for HEDIS reporting, such as laboratory test results, hypertension verification, and the most recent blood pressure reading. The specialist collects medical record data, identifies improvements affecting HEDIS measures, reviews noncompliant reports, flags patient charts for missing measures, and requests quality documentation from outside resources. The position works with leadership to execute quality strategies, manages reports and monitors performance at the group and provider levels, and engages PCPs and clinic staff to develop strategies to close quality gaps. The specialist also uploads HEDIS data to medical records and sends it to the health plan, along with performing other related duties as assigned.
Requirements
- High school diploma.
Nice To Haves
- Certified Medical Assistant or Registered Medical Assistant.
- Bachelor of Science degree, a degree in another related field, or foreign medical graduate.
- One year of experience in care coordination in an outpatient setting, HMO, MSO, or ACO.
Responsibilities
- Support the Wellness & Preventative Management Program, including HEDIS, Annual Wellness Visits, appointments, and other care coordination tasks.
- Review assigned medical records and abstract clinical data elements for HEDIS reporting.
- Collect medical record data and identify needed improvements that impact HEDIS measures.
- Review noncompliant reports and flag patient charts with missing measures.
- Request quality data documentation from outside resources.
- Work closely with leadership to execute quality strategies.
- Manage reports and monitor performance at the group and provider levels.
- Engage PCPs and clinic staff in developing strategies to close quality gaps.
- Upload HEDIS data to medical records and send it to the health plan.
- Perform 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
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
