Quality Practice Advisor Associate with HEDIS

Quality Practice Advisor Associate with HEDIS

Location: Houston TX 77081 Key skills Subject matter expert in HEDIS, Risk Adjustment, Medicare, and Medicaid

Day to Day Responsibilities of this Position and Description of Project:

• Serve as a liaison to practices to provide on-site and remote assistance and facilitation to the clinicians, care teams and their associated practices to drive improvement in clinical quality and operational efficiency.
• Develop and execute set of intervention work plans to drive practice improve quality measures and transformation.
• Develop and implement workflow design and redesign, including electronic health record (EHR) optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting.
• Develop and implement changes to root causes of financial and quality underperformance and communicate strategies to providers and provider groups.
• Review and interpret summary data and performance reports such as pay for performance, HEDIS and medical cost ratio and develop data driven provider performance strategies.
• Actively participate in cross-functional teams to conduct work and resolve enterprise and regional issues.
• Identifies provider specific metrics and coaches providers on gap closing opportunities. Provide support to address specific practice needs.
• Collaborates with Quality, Risk Adjustment and Operations to improve provider performance.
• Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education by providing resources and educational opportunities to provider and staff.
• Functions as HEDIS subject matter expert in consultation with provider practices by conducting internal audits for provider compliance with regulatory and NCQA accreditation standards, and monitoring and providing consultation to departments to correct deficiencies.
• Drives implementation of market specific strategies that improve quality and outcomes.

Internal/External Groups with which the Candidate will interface:

Required Skills: - See Free Space on page 2 - Preferred Skills:

• 4+ combined years in medical practice management, clinical program development, clinical transformation, health care quality analytics, and/or quality improvement
• Prior experience working at a health plan
• 1+ of those years must include experience interpreting and utilizing clinical data analytics to formulate data driven health care strategy
• Clinic or practice management experience.
• 1+ of those years must include experience with value based care arrangements (ACOs or IPAs)
• Patient facing experience and/or clinical licensure
• 1+ of those years must have been in a provider facing setting.
• Experience presenting to executives, physicians, and clinical leadership
• Bachelor's degree required - Education Preferred: Master's

Software Skills Required: - Intermediate Excel (must be able to sort, filter, pivot, and VLOOKUP data), Power Point, Word, and Outlook

Other Necessary Skills: - Data analysis, public speaking, quality improvement