Job description

Job Title: Quality Improvement Specialist 2

Location: Remote for FL but employee must reside in one of the following counties- Orange, Osceola, Seminole or Brevard as they will be required to travel to Providers offices in that region.

Duration: 6+ Months (Possible extension)

Job Description:

Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.

Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.

Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).

Identifies specific practice needs where client can provide support.

Develops, enhances and maintains provider clinical relationship across product lines.

Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):

Working and developing strong relationships with assigned provider groups and delivering time sensitive reporting for HEDIS care gap closure. Educating providers on proper coding and gap closure. Working with teammates on additional projects to assist in gap closure. HEDIS record collection, data entry and overreading of records during “chart chase season” which measures our plan performance

Describe the performance expectations/metrics for this individual and their team:

Timely delivery of care gap reporting to providers (within 3 business days); documenting provider visits within 5 business days in the appropriate system. Ensuring other time sensitive reporting is sent to providers within a timely manner. Educating providers to assist in score improvement year over year. During HEDIS chart chase (FEB-May) -chart retrieval, data entry and overreading of charts. Working collaboratively with other departments on provider visits and education.

What previous job titles or background work will in this role?

LPN, RN, Medical Assistant, CMA, Experience with HEDIS, Bachelor Nursing, CPC

Required Skills/Experience:

HEDIS knowledge

Strong computer skills—excel, word, PowerPoint, outlook, teams

Customer service /Provider facing experience

Preferred Skills/ Experience:

Clinical Background /degree

Team Oriented

Medical office experience

Certifications:
Preferred Certifications but not required if candidate has experience with HEDIS /Quality - CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, HCQM, CHP, CPHQ.

Job Type: Contract

Pay: $34.00 - $35.00 per hour

Schedule:

• 8 hour shift

Experience:

• HEDIS: 5 years (Preferred)
• Clinical: 5 years (Preferred)
• Medical records: 5 years (Preferred)

License/Certification:

• Certified Medical Assistant (Preferred)
• Licensed Clinical Social Worker (Preferred)
• LPN (Preferred)
• LMHC (Preferred)
• LMSW (Preferred)
• LVN (Preferred)
• CPHQ (Preferred)

Work Location: Remote

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