Quality Performance Specialist Details

Quality Performance Specialist

Access Community Health Network - Chicago, IL

Employment Type : Full-Time

Quality Performance Specialist600 W Fulton St, Chicago, IL 60661, USA Req #166

Tuesday, January 12, 2021

Position Summary
The Quality Performance Specialist serves as a key point of contact and liaison between assigned strategic Managed Care Organization (MCOs) and various departments, including Quality, Operations, Managed Care/Finance, Revenue Cycle & Health Information Management (HIM), Medical Services, and other shared service departments. The quality performance specialist supports the Population Health Manager or Director of Quality to develop and execute the strategy for their assigned payors, including building strong working relationship; building trust, and helping providers improve their performance with key documentation and outreach strategies. The Quality Performance Specialist works closely with HIM team to ensure appropriate quality medical records review for care gap closure, as well as health center operations to provide support, communication, and education in alignment with the quality strategic plan.

What You Will Do

• Owns and manages the relationship and performance of key payor groups, act as liaison to support key quality strategic initiatives in alignment with ACCESS quality priorities and initiatives
• Utilizes Managed Care Organization (MCO) resources such as quality portal access and quality dashboard reports, reviews and strategizes on key quality measures to improve on financial performance
• Responsible for understanding HEDIS and STARS measures and partner with the Quality team to drive improved provider performance
• Assess quality of provider medical records, and conducts on-site reviews as needed at health centers
• Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics; provides coaching and feedback and develops targeted training to provider teams to improve quality, accuracy, and overall documentation
• Collaborates with interdepartmental teams including IS, operations, and revenue cycle team to ensure alignment of documentation and coding standards
  

Required Qualifications

• Bachelor’s degree in Health Care Administration, Public Health or Social Science related field
• Minimum two years’ experience performing medical record review in a clinical/medical setting
• Minimum 2 years’ experience with coding and documentation
• Knowledge of managed care principles, NCQA standards, and HEDIS principles, ICD diagnosis coding, Risk Adjustment HCC/Coding experience
• Working knowledge of electronic health records system
• Intermediate proficiency in Microsoft Office Suite (highly skilled in PowerPoint and Excel)

Preferred Qualifications

• RN license
• Minimum of 1-2 years HEDIS experience
• Certified Professional Coder
• Working knowledge ofEPIC Clinical Software System

Who We Are

ACCESS is at the forefront of expanding access to affordable, comprehensive healthcare. We understand that we must continually work to evolve our thinking around patient care. As a community health care leader, we know that regardless of all the resources and advancements in medicine today, patient engagement is the most critical element in improving health outcomes. To achieve this outcome, we innovate and develop better practices to improve our care delivery model. To continue successfully down this path, we search for candidates who share our values and goals.

We don’t discriminate for any reason. We welcome talent who believes in our mission, drives the organization forward and cares about the value they bring to an organization.

Other details

• Pay Type

  Salary