Quality Specialist

Quality Specialist Job Description

The ideal candidate for this role is compassionate, flexible, self‑motivated, detail oriented, and a constant learner. As a Quality Specialist, you will be the subject matter expert for HEDIS/Gaps in Care measures. You will ensure maintenance of programs for patients in accordance with prescribed quality standards; conduct data collection, reporting and monitoring for key performance measurement activities recognized by the NCQA.

Responsibilities

• Provides expertise in analysis of data related to supporting value‑based programs. Skills include accessing internal databases and tables as well as utilizing Excel skills.
• Participates in meetings with vendors for the medical record collection process and assists Manager with medical record vendor oversight.
• Participates in projects to ensure the strategic directives of the stakeholders are executed and time‑sensitive deadlines are met.
• Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidence, documentation, and changes.
• Monitor, evaluate and report on program status inclusive of scope, schedule, budget and alignment to program and strategic goals.
• Direct corrective action, as needed, to maintain the viability of value‑based reimbursement programs.
• Provide training and education to staff related to the data available, how to access it, and what metrics might be of interest.

Qualifications

• Bachelor’s Degree in related field and two (2) years’ experience in the health industry. An equivalent combination of education and experience may be substituted to meet this requirement.
• HEDIS/Gaps in Care experience.
• Knowledge of payers and their requirements for each measure.
• Knowledge of Patient Centered Medical Homes and Accountable Care Organizations.
• Microsoft Office skills.
• The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
• Tracking key performance indicators.

Benefits

• Competitive compensation and benefits package.
• Bi‑weekly competitive pay.
• Opportunities for professional and personal growth.
• Excellent health insurance through Blue Care Network with a VIP policy.
• Premium dental and vision coverage.
• Buy‑up option for short‑ and long‑term disability, and life & AD&D insurance.
• 401(k) investment opportunities.
• Generous holiday, vacation and personal time.
• Work/life balance.
• Employee recognition and assistance programs.