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HEDIS Quality Specialist

2 months ago

Miami, United States Borinquen Health Care Center Full time
About the Role

Borinquen Health Care Center is seeking a highly skilled HEDIS Quality Specialist to join our team. As a key member of our clinical operations team, you will play a critical role in ensuring the quality and accuracy of our patient data.

Key Responsibilities
  1. Quality Data Management: Coordinate and complete HEDIS quality-specific projects, ensuring consistency with our organization's strategy, commitments, and goals.
  2. Patient Roster Management: Obtain patient rosters from participating health insurance plans and validate them to ensure accuracy.
  3. Scheduling and Compliance: Schedule appointments and ensure compliance with quality measures, track quality measures, and sell BHCC services as needed.
  4. Chronic Care Management: Assist with chronic care management, including sharing medical appointments, completing care gaps, and assisting with group visits.
  5. Data Analysis and Reporting: Track hospitalization discharges, bring patients back for continuity of care, and proactively seek resources to identify gaps in existing or quality projects.
  6. Record Auditing: Periodically audit records to confirm compliance with HEDIS and NCQA standards.
  7. Patient Engagement: Ensure that all scheduled and tracking attended patients fulfill their care gaps and document barriers to doing so.
  8. Registration and Data Updates: Verify and update patient registration information, including insurance, demographic, and patient data when scheduling appointments.
  9. Internal Rosters and Leakage Mitigation: Maintain internal rosters to mitigate inadvertent leakage resulting from incorrect listings.
  10. Data Communication and Presentation: Retrieve, communicate, present data and information both verbally and written.
  11. Paneling and Quality Manager Coordination: Provide paneling information to health plans is accurate and timely, and coordinate with the Quality Manager on a weekly basis.
  12. Chart Audits and Call Campaigns: Perform and track call campaigns for non-compliant patients to increase access to care, and increase and track access to care for patients who have not attended in the last six months their primary care provider visit.
Requirements
  1. Education: Associate's college degree or higher.
  2. Language Skills: Bilingual (Spanish and/or Creole) and excellent communication skills.
  3. Computer Literacy: Proficiency and expertise in Microsoft Office, including Outlook, Word, and Excel.
  4. Interpersonal Skills: Ability to interact effectively with patients, administration, faculty, and staff.
  5. Confidentiality: Handle information with a high level of confidentiality.
  6. Knowledge and Experience: Considerable knowledge of standard concepts, practices, and procedures within a field, and minimum 1 year of customer service experience.
  7. Strong Interpersonal Skills: Strong interpersonal skills and ability to work in a team environment.