Quality Specialist

Job Description Summary The Quality Specialist supports the Wellness & Preventive Management (WPM) Program, focusing on HEDIS measures, Annual Wellness Visits (AWVs), and care gap closure. This role is responsible for reviewing medical records, abstracting clinical data, identifying missing quality measures, and collaborating with providers and clinic staff to improve performance and patient outcomes. Position Responsibilities Responsible for supporting the Wellness & Preventative Management Program (WPM): HEDIS, Annual Wellness Visits, Appointments, and other Care Coordination tasks. Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g. results of laboratory tests, verification of hypertension and the most recent blood pressure reading. Collect medical record data and identify needed improvements that impact HEDIS measures. Review noncompliant reports and flags patient’s charts with the missing measures. Request quality data documentation from outside resources. Works closely with leadership to execute quality strategies. Manage the reports and monitor performance at group and providers level. Engages PCP and clinic staff in developing strategies to close quality gaps. Upload HEDIS data to medical records and send it to the health plan. Performs all other related duties as assigned. Qualifications License/Registration/Certification Preferred Certified Medical Assistant or Registered Medical Assistant. Education Required: High School Diploma. Preferred: Bachelor of Sciences degree or in related field, foreign medical graduate. Experience Preferred: One year of experience in Care Coordination in an outpatient setting or HMO, MSO or ACO. Benefits Health benefits Life insurance Long-term disability coverage Healthcare spending accounts Retirement plan Paid time off Pet Insurance Tuition reimbursement Employee assistance program Wellness program On-site housing for select positions and more! #J-18808-Ljbffr Mount Sinai Medical Center