HEDIS/STARs Specialist
4 weeks ago
The Quality Management department is seeking a HEDIS/STARs Specialist to assist with clinic engagement in quality performance and patient experience programs. This is a position that may include field work to train staff and providers as well as performing chart abstracts.
Duties and Responsibilities:
1. Assume primary responsibility for quality improvement functions including working with patient navigators and other provider staff
2. Responsible for educating providers and their staff on HEDIS and STARs measures
3. Establish relationships with providers and staff to foster ongoing collaboration for data collection efforts
4. Recommend workflow efficiencies to providers and their staff in an effort to improve HEDIS scores
5. Perform research, data entry and quality control on key data sources following prescribed guidelines/protocols, data entry and quality control on key data sources following prescribed guidelines/protocols in support of regulatory reporting requirements including: HEDIS, STARs, AMP, Risk Adjustment and other quality activities
6. Train providers and staff on health plan P4P incentive programs; track progress and make recommendations for success
7. Identifies member service gaps and reviews reports with providers and their staff
8. Collects medical records and reports from provider offices based on member needed services reports and gaps
9. Works directly with other HEDIS/STARs specialists at MedPOINT as well as health plan staff to monitor the gap closures and improvement activities
10. Assists the Provider/Clinic QM staff with physician and member interventions and incentive efforts as applicable
11. Participates in scheduled meetings with the MedPOINT QM Specialist team and health plans
12. Trains offices in COZEVA HEDIS platform and track usage
13. Assist with member outreach efforts as directed
14. Submit actionable work plans to health plans and track progress
15. Supplemental data submission and tracking
16. Create and present provider training materials
17. Perform a broad range of administrative duties using initiative and judgment in handling confidential and time sensitive information
18. Additional QM tasks as directed by leadership including work with other IPAs as able
Minimum Qualifications:
· High school graduate or GED equivalent
· Minimum of four years’ experience working in a quality department in a health plan or IPA quality environment
· Working knowledge of NCQA HEDIS measure requirements
· Willing to travel if required to provider offices/ clinics in greater Los Angeles area
Knowledge, Skills and Abilities Required:
· Effective verbal and written communication skills
· Good interpersonal skills
· Ability to multitask in a busy department environment
· Able to work with large files and data sets
· Excellent project management and organizational skills
· Able to work well remotely in independent environment
· Microsoft Office skilled (particularly with Word, Excel and Power Point)
· Technical aptitude to navigate various Electronic Medical Records (EMR) systems in order to skillfully extract needed data per specified project needs
· Knowledge of COZEVA quality platform a plus
· Strong skills to function effectively as part of intradepartmental and interdepartmental teams
· EZ-CAP® knowledge a plus
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