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Quality Improvement Specialist HEDIS and CMS - Hybrid

Company: ApolloMed
Location: Alhambra
Posted on: September 23, 2022

Job Description:

ApolloMed is looking for a Quality Improvement Specialist who will work at our Alhambra office at 1668 South Garfield Avenue. This position will have the ability to work remotely some days! This position will also require some travel to provider sites dependent on projects. The shift will typically be M-F from 8am to 4:30pm.You will be responsible for working with our network providers in improving quality of care through quality improvement activities that will encompass HEDIS, CMS Star Rating, and health plan quality performance reporting.ESSENTIAL DUTIES AND RESPONSIBILITIES: Other duties may be assignedComply with department policy and proceduresCollect and collate appropriate data from IPA network providers for HEDIS measuresCollect medical records, conduct reviews and ensure accuracy of documentation for reportingCollect, summarize and trend provider performance data to include provider educationParticipate in ongoing discussions concerning data collections and analysis for HEDISAssist in planning and implementation of projects to improve delivery of services and quality of careUnderstand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAAProvide in-service training to providers regarding HEDIS and CMS Star MeasuresGenerate and maintain accurate weekly/monthly/quarterly report of activitiesConduct Provider Training (PCPs& Specialist) that would include but is not limited to:Quality MeasuresHEDIS and STAR measuresIncentive ProgramsData and documentation integrity and accuracyAttend to health plan, provider, and interdepartmental callsPerform other duties, projects, and actions as assignedQUALIFICATIONS:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.REQUIRED:Bachelor's degree or equivalent years of experience3-5 years of IPA/MSO/HP or general healthcare experienceAt least one (1) year of HEDIS related experienceExperience explaining data reports to practitioners and educating providersExperience using Microsoft applications such as Word, Excel and OutlookAbility to drive in the state of CaliforniaPREFERRED:Fluent in Spanish and/or ChineseExperience in data analytics and reportingKnowledge of practice management and/or financial aspects of the practiceExcellent analytical critical reasoning and interpersonal communication skillAbility to work in a fast-paced environmentAbility to keep a high-level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies, and other sensitive information

Keywords: ApolloMed, Alhambra , Quality Improvement Specialist HEDIS and CMS - Hybrid, Other , Alhambra, California

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