Quality Metric Specialist

Benefits
Health Insurance, Life Insurance, Paid Holidays, Paid Vacation
Job Description
Pay Range: $26.00 to $34.00 per hour, Depends on Experience (DOE)

Location: City Heights

Summary

Quality Metric Specialist, this position performs duties that emphasize quality of care, patient safety and customer service. The Quality Metric Specialist is responsible for ensuring that all patients, assigned to the clinic by the health plans, are scheduled for appropriate appointments addressing any HEDIS/ QI gaps measures, according to the National Committee for Quality Assurance (NCQA) guidelines. They are to ensure that all patients are seen for the accurate visits, within the required timeframe, depending on HEDIS/QI care gaps measures and conduct follow-up reminders as needed. The Quality Metric Specialist also performs electronic health record reviews, abstractions and data entry. It requires working in collaboration with clinical and non-clinical staff to ensure coordinated care and proper appointment scheduling.

Responsibilities of HEDIS Specialist

• Utilize the SSRS, SharePoint and reporting tool to filter through the HEDIS/QI gap lists and submit any eligible dates of service to close relevant measures
• Responsible for verifying insurance eligibility prior to patient outreach
  Able to navigate health plan portals
• Retrieve records and send over the health plan via fax or portal
• Contacting patients to schedule appointments regarding missing HEDIS/QI measures as well as answering incoming calls and ensuring appropriate documentation is noted in EMR
• Case Manage patients to track all expected appointments and follow-up with any no-shows or cancelations to ensure patients are seen for all required measures
• Completes appointment reminders by calling/ texting patients to confirm any HEDIS/QI related appointments
• Knowledgeable with Pediatric, Family Practice, BH/WSS, Optometry and OB/GYN measures as well as scheduling restrictions and rules for all LMFC departments including Primary Care and specialties
• Able to navigate EMR to abstract clinical data elements for completed measures
• Faxing records request
• Daily Productivity: SSRS entries, and schedule appointments which productivity goal can vary depending on the department’s needs
• Provide a daily report at end of work day to management
• Answer incoming call
• Attends monthly meetings with each health plan and participates accordingly
• Meeting deadlines
• Attend department meetings and taking note minute meetings
• Managing emails and following up if needed
• Work closely with varies departments to ensure patients are closing their missing gaps
• Remains familiar and up- to- date with all policies, procedures and protocols pertaining to HEDIS/ NCQA/ QI, maintains effective communication and working relationship with other employees and patients
• Assists with filtering through any additional spreadsheets received by health plans for incentivized projects on an as needed basis and conducts outreach accordingly to meet deadlines
• Conducts outreach to any patients deemed eligible by health plan to receive a gift card and documents all contact efforts, maintains communication with all relevant departments involved in distribution ensuring proper forms are signed and returned
• Responsible for extraction and combination of medical records, faxing and/or uploading records and following up with health plans as requested
• Work with health plans when needed to ensure proof of visits and services are captured
• Check department voicemail messages and take suitable action (i.e. call back patient, schedule appointment, forwarding message information to intended recipient, etc.) All voicemails are expected to be checked daily
• Attend staff meetings
• Performs other duties as assigned.
• Remain familiar and up to date with all policies, procedures, and protocols pertaining to HEDIS/NCQA

Job Requirements

Education: High School Diploma, GED or equivalent

Certification: CPR certification required.

Experience: 1-2 years of experience in physician office, health plan or hospital setting preferred. Medical Assistant Certificate preferred.

Verbal and Written Skills to perform the job: Bilingual preferred. Familiarity with basic word processing, spreadsheet, and database applications. Accurate keyboarding skills.

Technical knowledge and skills required to perform the job: Excellent verbal, written and interpersonal communication skills and the demonstrated ability to work with diverse individuals and groups. Demonstrate high levels of self-initiation and direction. Knowledge of communities we serve. Knowledge and experience working in medical settings and interacting collaboratively with medical teams. Skill in analyzing situations and making timely decisions.

Physical and Mental Requirements: Work involves sitting, talking, hearing, using hands to handle, feel or operate objects, tools, or controls, and reaching with hands and arms. The employee may be required to push, pull, lift, and/or carry up to 20 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

La Maestra Community Health Centers is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation or belief.