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HEDIS Quality Coordinator

2 months ago

Stockton, United States P3 Health Partners Full time
People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

We are looking for a HEDIS Quality Coordinator. If you are passionate about your work, eager to have fun; and motivated to be part of a fast-growing organization in Stockton, CA, then you should consider joining our team.

Overall Purpose:

The HEDIS Quality Coordinator supports HEDIS quality gap closures and supports the regional quality team under the direction of the Quality Manager. Through provider and patient engagement, the HEDIS Quality Coordinator assists patients and affiliates in ensuring HEDIS quality gap closure, documentation, and submittal to health plan. This position provides telephonic outreach to patients to provide patient education and engagement regarding annual screenings, medication adherence, and appropriate follow up with primary care provider.

This position has access to various electronic health records to data mine quality measure data and collating that data for submittal to the health plan. This position, depending on education and experience, may directly interact with patients in their home to ensure appropriate HEDIS measures are closed such as obtaining patient blood pressure, diabetic eye exams, and distribution of screening materials.

The Quality Management team ensures compliance with policies and procedures as dictated by but not limited to the following: Centers for Medicare and Medicaid Services (CMS), the National Committee on Quality Assurance (NCQA), and respective health plans.

Essential Duties and Responsibilities:

Participates in data collecting through medical record and claims surveillance
Responsible for reviewing data collected to confirm gaps in care are captured
Conduct data entry and maintain appropriate documentation and tracking for quality initiatives
Conducts telephonic outreach to specified patients on priority lists for any outstanding care gaps and schedule accordingly
Educating patients on procedures that are being scheduled/performed and the reason for performing them
Supports and educates affiliate practices on optimizing HEDIS gap closure
Depending on education and experience – conduct in home HEDIS gap closure for select measures such as blood pressures, diabetic eye exams, point of care hemoglobin a1c testing, distribution of colorectal screening kits

Knowledge, Skills, and Abilities:

Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA
Knowledge of federal, national, state, and health plan regulatory requirements, as well as managed care and health plan standards
Strong analytical, critical thinking, and problem-solving skills
Data mining experience
Excellent interpersonal and communication skills with patients, providers, internal and external stakeholders
Excellent organizational and time management skills
Depending on education and experience - demonstrate knowledge of vital signs and other clinical skills related to direct patient care for quality gap closure

Minimum Education and Experience:

High school diploma or GED equivalent
Current CPR
2+ years in healthcare environment
Experience with Microsoft Word, Excel, Power Point, Outlook
Experience in Electronic Health Records
Medical terminology knowledge

Preferred Education and Experience:

Associate degree in related field or equivalent experience
3+ years health care related experience, managed care, or health insurance experience
Medical Assistant certification and/or Pharmacy Technician certification
CPHQ (Certified Professional in Healthcare Quality)
Experience with CPT II codes

Pay range: $21-22/hr

Education
Required
High School or better
Preferred
Associates or better
Licenses & Certifications
Required
CPR Certification
Preferred
MA Certification

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)