HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.HCPs vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCPs mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Quality Specialist for our Garden City, NY office.Position Summary: The Quality Specialist (QS) works with the Director of Quality, provider engagement team, care management and other internal teams to develop resources for engagement, training, and educating providers to improve Healthcare Effectiveness Data and Information Set (HEDIS) performance rates for Medicare, Medicaid, and our Commercial lines of business. The QS will also support CAHPS activities that pertain to the member experience surveys. The QS will assist in supporting member and provider outreach campaigns. The QS will collaborate with provider engagement representatives to train and share best practices related to improving Quality. The QS supports measure-specific initiatives utilizing the Plan Do Study Act (PDSA) model and performs member and/or provider outreach, education and engagement, data analysis, medical record abstraction and data entry to support continuous quality improvement in HEDIS. Essential Position Functions/Responsibilities:
- Develop tools for targeted providers to discuss programs focused on improving the quality of care for HCP members.
- Develop strategic plan that identifies opportunities for patient outreach and execution of member engagement.
- Develop the PDSA cycle for measure-specific initiatives and facilitate provider and/or member outreach to ensure member receipt of important clinical services to improve health outcomes and support efficient medical record retrieval for HEDIS medical record review and HEDIS supplemental data collection activities.
- Monitor HEDIS/QARR report cards monthly; identify areas of concern, and communicate with provider contacts; utilizing the results of the performance report cards and input from the providers, develop/update action plans; monitor efforts to address performance improvement opportunities in NYSDOH 75th and 90th percentile benchmarks.
- Assist in the development of provider and member tools and resources based on feedback and identified opportunities to support providers and members with overcoming any barriers.
- Audits medical records retrieved for HEDIS collected by the provider engagement team and educates on opportunities for provider/provider entity regarding HEDIS coding and documentation.
- Educate and train provider engagement team on quality, and coding opportunities for public facing with providers.
- Conduct monthly meetings with provider engagement team to provide feedback on results of chart collection, chart audits and areas in which there are coding and/or documentation deficiencies and how the provider office can improve on closing gaps in care.
- Collaborate with provider offices and their EMR vendors to maximize HEDIS measure capture/gap closure and output of codes found in the HEDIS value set in their EMR systems.
- Work with provider offices on paper charts and guide their billing staff and/or company on appropriate HEDIS codes to ensure maximum HEDIS measure capture/gap closure.
- Identify trends to collaborate with providers to improve member health outcomes and HEDIS measure performance.
- Maintain current knowledge of lCD-I0 and CPT coding, HEDIS measure technical specifications, NYS and CMS documentation requirements.
- Proactively recognize problems and respond appropriately with suggested solutions in a professional manner; escalate any issues with members, providers or office staff to appropriate management and/or team members.
- Contribute to the development of incentive programs and provide ongoing training and coaching to providers on program implementation and barrier resolution; training includes but is not limited to HEDIS/QARR/CAHPS.
- Apply understanding of physician/facility practices and support practice transformation; translate business needs into practical applications and innovative solutions.
- Support and participate in quality improvement processes and initiatives.
- Work with several reports and software systems for documentation, coding and reporting.
- Other duties as assigned by leadership.
Qualification Requirements:Skills, Knowledge, Abilities
- Superior interpersonal skills with the ability to work collaboratively and build positive relationships with key provider partners and team members across the organization as well as influence with and without formal authority to drive performance outcomes.
- Ability to work in a multidisciplinary team in a fast-paced environment with changing priorities.
- Strong attention to detail with highly effective written and verbal communication and presentation skills.
- Superior organizational, relationship management and multi-tasking skills in order to meet commitments and deadlines.
- Possess solid results-oriented process improvement capabilities.
- Exceptional problem solving/critical thinking skills and ability to learn new skills quickly; self-starter.
- Strong decision-making and problem-solving capabilities.
- Ability to develop needed processes to complete tasks and identify opportunities for synergy and integration.
- Must be able to make effective and timely decisions by organizing information in a useful manner and orchestrating multiple activities at once to accomplish the goal at hand.
- Demonstrate ability to give close attention to details for accuracy, including planning, executing, and follow up procedures.
- Ability to travel within the HCP service area.
- Proficiency in MS Excel, Word, PowerPoint
Training/Education:
- Bachelor's Degree or combination of education and experience, required
- Lean Six Sigma experience preferred
Experience:
- 2 years of managed care or health care industry experience, required
- Knowledge of Medicare Stars for Medicare, and HEDIS/QARR requirements for Medicaid line of business including medical record review and/or reporting processes, preferred
Base Compensation; $60,000 - $75,000 annually ($28-$36 per hour)Bonus Incentive: Up to 5% of base salaryHealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.