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POSITION DESCRIPTION
This position is responsible to serve as primary liaison between physicians and Innovacare Partners for the purposes of achieving and enhancing overall quality performance and metrics for InnovaCare Partner practices. The coordinator is responsible for the direct coordination of work flow regarding quality gap measures pending with the office clinical and administrative staff in order to achieve a five Star MA rating and high overall Hedis scores. The coordinator also ensures that all quality data is collated, coded accurately and reports are monitored and trended regularly, including the reconciliation of payor reports to ensure gap has been captured and attributed to the practice appropriately. The Practice Quality coordinator needs to have the ability to manage multiple tasks at once, prioritize information to be shared with the practice and collaborate across all staff in the practice.RESPONSIBILITIES
It is required that the Practice Quality Coordinator is familiar with current managed care industry standard practice work flow’s associated to collecting quality measures from desperate sources across the practice (including mining EMR data) along with outside vendors and payors. The position needs to have technical knowledge about Hedis/STARs measures, the rating methodology, and appropriate CPT/ICD coding protocols. The coordinator should be familiar with patient experience and how to manage patient outreach to gain compliance with satisfying STARs/Hedis measures.
PCP data analysis (Preventive Gaps in Care, Pharmacy, Patient Experience, among other parameters in alignment with targeted CMS and State measures and corresponding populations) Identify opportunities and develop action plans to improve overall practice work flow to close gaps in care Comprehensive chart review abstraction based on current CMS STARs program Capable to do clinical correlations to increase quality care of patients in the practice Review medical records and supplemental documentation such as medical visits and diagnosis in order to identify missing elements for gaps closure as well as for coding purposes. Maintains and monitors all associated reporting to management along with raising urgent issues and indicators in order to pivot strategies quickly Responsible for coordination with office administrators of any medical records related to quality chart review request from insurance companies or other entities Identify and follow up with billing departments, medical assistants documentation errors regarding Hedis/STARs coding Continually educate self on latest information related to Stars Rating Program, Quality Measures, and thresholds as established by payers and other contracting entities. Supports special projects as assigned. Represents the company in special activities for providers and patients relations.
EDUCATION AND EXPERIENCEBachelor’s degree in Health Care Administration or related degree in health care.
Minimum of 3-5 years experience working with Hedis/STAR Rating or Quality Clinical Measure program.
GENERAL KNOWLEDGE/SKILLS- Knowledge on HEDIS measures, CMS Star Ratings Methodology, Coding, Provider Compensation Models, Claims Billing Cycles, and CMS regulation.
- Knowledge of internal applications and electronic medical records management.
- Computer skills: proficient in Word, Excel, Power Point and Outlook.
- Ability to respond to a high volume of work and always maintain a polite and professional attitude.
- Able to function with frequent interruptions.
- Ability to prioritize workloads for maximum efficiency.
- Customer Service Skills: practicing, valuing and supporting service to both internal and external customers
- Time Management Skills: establishing priorities and accomplishing tasks in a timely manner
- Team Work: ability to work in a team environment to create solutions to problems
- Ability to work independently
- Strong analytical and problem-solving skills; ability analyze and interpret data
- Ability to effectively present and explain information and respond to questions
- Project management skills
ENVIRONMENTAL AND WORKING CONDITIONS
While working the employee in siting, walking, talking and listening. Position will require a valid drivers license and will travel approximately 30% of time.
