Quality Specialist

Mount Sinai Medical Center•Hialeah, FL

12d

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 medical records and abstracts clinical data for HEDIS reporting, identifies improvements that may affect HEDIS measures, and helps coordinate efforts to close quality gaps. The specialist works with leadership, primary care physicians, and clinic staff, manages performance reports, and uploads HEDIS data to medical records and health plans.

Requirements

High school diploma required.

Nice To Haves

Certified Medical Assistant or Registered Medical Assistant certification preferred.
Bachelor of Science degree, degree in another related field, or foreign medical graduate preferred.
One year of experience in care coordination in an outpatient setting, HMO, MSO, or ACO preferred.

Responsibilities

Review assigned medical records and abstract clinical data for HEDIS reporting, such as laboratory results and hypertension verification with the most recent blood pressure reading.
Collect medical record data and identify needed improvements that affect HEDIS measures.
Review noncompliant reports and flag patient charts for missing measures.
Request quality data documentation from outside resources.
Work with leadership to execute quality strategies.
Manage reports and monitor performance at group and provider levels.
Engage primary care physicians and clinic staff in developing strategies to close quality gaps.
Upload HEDIS data to medical records and send it to the health plan.
Support the Wellness & Preventative Management Program, including HEDIS, Annual Wellness Visits, appointments, and care coordination tasks.
Perform other related duties as assigned.