Quality Reporting Specialist

Primary Duties

The Quality Reporting Specialist plays a critical role ensuring practice and ACO success in our Medicare Advantage and commercial contracts with a focus on HEDIS quality measures . The Specialist must be service-oriented, well-versed in HEDIS quality measures , and familiar with approaches for reviewing ambulatory care charts both electronic ( EHRs ) and paper to identify and submit documentation to address quality measure gap closure. This role requires strong attention to detail, great communication skills (both oral and written), and a passion for quality measure performance.

• Apply knowledge of HEDIS quality measures for addressing incentivized, contract measures across multiple Medicare Advantage and commercial health plans to ensure practice and ACO receive credit for services received by patient

• Access practices in-person or remotely to retrieve documentation to address quality gaps and / or work closely with field team to assist guiding practices through gap closures

• Submit documentation to health plans and employ optimal method in each practice (i.e., upload to payor portal, secure email, etc)

• Coordinates Electronic Health Record (EHR) system access set-up & login management

• Consult with market field team members on quality reporting strategy - providing relevant market updates and chart review feedback for assigned practices

Minimum Qualifications

• 1+ years experience in quality reporting in healthcare or health plan setting

• Experience working within at least one (1) major Electronic Health Record system (athenaHealth, eCW, etc)

• Comfortable exporting data, formatting and reporting out results ( Excel or Google Sheets experience )

• Able to work independently and prioritize deadlines

• Track and communicate progress; escalate barriers to performance

• Strong written and verbal communication skills

• Strong attention to detail

Preferred knowledge, skills, and/or abilities

• Bachelor’s degree is preferred or equivalent work experience

• G-Suite Proficiency

• Experience working with the Medicare Advantage STARS program and HEDIS measures

Physical Requirements

Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.