Specialist, Quality

Suvida Healthcare•Tucson, AZ

57d•Onsite

About The Position

The Specialist, Quality will work closely with our clinic staff to identify gaps in care, capture HEDIS documentation, perform chart audits, track patient engagement in care gap, and notify clinics of time sensitive care caps. They will also work with the Director of Quality to report low clinic engagement, opportunities for staff education, and reporting inaccuracies. Essential responsibilities consist of, but are not limited of the following:

Requirements

Bachelor's degree in healthcare administration or public health required
One of the following certifications, accompanied by 2+ years of experience in value-based care setting (primary care or Medicare Advantage Plans preferred): Certified Medical Assistant, Certified Pharmacy Technician, Certified Nursing Assistant, NCQA certification
OR 4+ years of experience in value-based care setting (primary care or Medicare Advantage Plans preferred)
2+ years of HEDIS or Risk Adjustment experience in supplemental data and chart reviews
Knowledge of CMS STARS program
Must have a basic understanding of billing and claims coding
Experience reviewing Electronic Medical Records
Intermediate level experience in working in Microsoft Excel, Word, and PowerPoint
Experience navigating payer portals.
At least 1 year of experience utilizing medical terminology.
Ability to work independently
Strong problem-solving skills with the ability to identify solutions independently and know when to appropriately escalate complex issues
Ability to multi-task
Ability to work in fast paced environments with changing priorities.

Nice To Haves

Bilingual (English/Spanish) preferred

Responsibilities

Identify and notify clinical staff of next steps needed to address open quality gaps.
Submit documentation to payer portal to close quality gaps.
Audit supplemental data to ensure results are compliant for identified measures.
Educate staff and providers on HEDIS technical specifications.
Resolve clinical staff Quality inquiries.
Join daily huddles as needed to inform clinical staff of patients with outstanding time sensitive measures.
Collaborate with other departments on quality specific projects to help reach quality goals.
Actively participate as a team player to promote positive health outcomes for our patients.
Able to work Monday-Friday from 8-5PM local time and be in the Arizona area.
Be willing to take on additional task to support the overall success of the organization.