Quality Information Specialist
Position: Quality Information Specialist
Full Time Employee
Reports To: Team Leader
The person in this position implements the Quality Improvement Program initiatives for an Independent Physician Association (IPA) under the direction of Precision Healthcare Delivery and the IPA Board with the assistance of the associated Medical Directors and IPA Team Leader.
The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
- Experience with healthcare quality management policies and procedures required
- Familiarity with NCQA and HEDIS measures required
- Understanding of basic statistical principles required
- Strong computer and analytical skills required
- Knowledge of ICD9/10 coding, HCC, HCPCS as related to quality measures, payments and risk scoring required
- Prior experience working in a healthcare setting required
- Experience in a Primary Care setting preferred
- Experience in Quality Management including Medicare, Medicare Advantage, Medicaid or Commercial Health Plans preferred
- Leadership: Ability to act independently to gather and communicate appropriate clinical and non-clinical information. Ability to communicate effectively with and give clear concise direction to the client. Ability to motivate staff and clients to improve performance.
- Communication: Ability to always represent PHD in a professional manner and in all forms of communication whether written, verbal or otherwise. Ability to accurately assess and quickly respond to customer/client requests. Able to manage conflict successfully.
- Organizational Knowledge: Ability to interpret and apply standard policies to highly variable situations. Ability to work in a collaborative environment as a team player.
- Technical Knowledge: Knowledge and skills in computer operations including basic word processing and spread sheet functions. Ability to perform basic analytical functions and basic statistical concepts.
- Establish credibility with clinic physicians, patient care staff, payers and members enrolled in Health Plans with whom clients may contract as you collaborate in the development of quality improvement initiatives
- Organize a workflow that is responsive to client organizational strategies
- Collect, organize and analyze claims data and quality data indicators and be able to effectively explain statistical reports and clinical outcomes data in a way that supports improved client performance.
- Monitor and evaluate quality procedures and policies to achieve quality health care delivery.
- Implement Quality Improvement Program objectives according to the annual work plan.
- Develop, implement and evaluate indicators to measure the quality of and access to care and service within PHD Clients.
- Collect data systematically on provider performance and patient outcomes.
- Promote physician and facility awareness of preventive guidelines and HEDIS measures as well as client contracted quality measures.
- Assure that quality concerns are identified, investigated and that corrective actions result in improvement.
- Maintain compliance with certification standards.
- Participate in or facilitate the completion of CQI projects that are organized to improve the outcomes of medical management processes.
- Collaborate with Health Plans on quality and payment initiatives and strategic planning.
- Candidate must be willing to travel 50% of the time regionally to the State of Kentucky.
- Multiple locations
- M-F 8AM to 5PM
Salary: $42,000.00 - $47,000.00 per year
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Paid time off
- Vision insurance
- Bachelor's (Preferred)
- Healthcare Quality and/or Data experience: 1 year (Preferred)