Quality Medical Assistant MA WellMed Irving Texas

Clinical Quality Coordinator

This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records. The Clinical Quality Coordinator will have a duty to provide a standard of care that meets or exceeds that of a reasonably competent and knowledgeable Medical Assistant.

Primary Responsibilities:

• Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff
• Review medical records for data collection, data entry, and quality monitoring including health plan/WellMed form submission and chart collection activities that close gaps in care
• Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice
• Communicate scheduling challenges or trends that may negatively impact quality outcomes
• Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments, lack of follow up on referrals, or inconsistent billing practices
• Activities may include data collection, data entry, quality monitoring, health plan/WellMed form submission and chart collection activities
• Assists with local IRR audits
• Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures
• Support chart chase process by requesting records from provider's offices as needed
• Maintains education/knowledge base of HEDIS/STARs
• Performs all other related duties as assigned

Required Qualifications:

• High School diploma or GED
• Sustained Medical Assistant certification
• Current BLS certification
• 3+ years of healthcare experience to include experience in a managed care setting
• 3+ years of experience with data analysis/quality chart reviews. Must be able to review data and provide recommendations for improvement
• 2+ years as a Certified Medical Assistant
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
• Proven ability to mentor others
• Expert in computer literacy in electronic health record
• Knowledge of medical terminology

Preferred Qualifications:

• Licensed Vocational/Registered Nurse, or Certified Professional Coder
• 1+ years of HEDIS/STAR experience or participation with similar regulatory reporting.
• 2+ years of college, in pursuance of a Bachelor's or Associate's degree.
• 2+ years of experience working with HEDIS/STAR measures.
• ICD 9/10 and CPT coding experience
• Experience working in a physician, provider, and/or medical office is preferred. EMR and HEDIS knowledge and experience

Physical & Mental Requirements:

• Ability to lift up to 10 pounds
• Ability to push or pull heavy objects using up to 50 pounds of force
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.