Quality Specialist - Summit Medical Group

Summit Medical Group is recruiting for a Quality Specialist which provides support services to our Quality Reporting & Improvement Team. Facilitates transfer of members’ quality records from legacy EHR to Athena for newly acquired practices. Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements by appropriately labeling and resulting, when applicable, completed testing for contracted members. Conducts HEDIS chart request and uploads documents into the EHR to close gaps within the members’ medical record. Supports quality measure gap closure through proper EHR documentation and attestation through payor portals. Assists Quality Specialist team with submission to payor portals, as needed. This is a full time opportunity.

Examples of Duties (List does not include all duties assigned)

• Provide Panel Management support to the VBC and Operations Teams. Generates patient rosters provided by VBC contracted payors and reviews for accuracy. Reviews include provider review, panel status review, and attribution concerns. Communicates roster concerns to appropriate payor or SMG contact.


• Assist with resolving site and provider concerns regarding panel issues and inaccuracies.


• Assist new SMG acquisitions with transfer of HEDIS quality data from historical EMR into Athena, ensuring proper closure of quality gaps.


• Provide administrative support to HEDIS activities to achieve quality goals, including but not limited to: retrieving medical records, remote and/or onsite provider office data collection, formulate and compile monthly reports. Request records from external providers to support HEDIS gap closure.


• Perform chart reviews to verify care gap status. If care gaps are open, will follow workflow for next steps to close care gaps to improve metric performance.


• Conduct telephonic outreach to patients to assist with scheduling needed preventive or chronic screenings. Communication is tailored to meet patient needs and medical jargon is avoided in patient interactions. Record and document all member outreach activities. Support practices and patients by scheduling appointments and screenings based on set protocols and follow call scripts in accordance with the outreach work plan. Place orders per protocol to support HEDIS gap closure.


• Transfer clinical information from patient charts into appropriate payor portal. Ensure timely and accurate submissions of attestations and documentation.


• Annual review of HEDIS standards to stay current on metric definitions, timing and updates.


• Validates reporting data as needed to ensure accuracy and alignment with outlined measure specifications set forth by HEDIS or other measure steward.


• Extract and analyze clinical data from EHRs and payor portals to assess performance against benchmarks. Monitor year-over-year performance to proactively identify metrics with declined performance. Proactively communicate performance concerns to VBC leadership team, as appropriate.


• Monitor compliance with policies and procedures relevant to clinical data management. Validates data for various quality programs. Adheres to expectations of the corporate compliance plan.


• Actively participate in site-level Quality Improvement Activities. Contribute to the continual evaluation of site performance as well as the implementation and measurement of improvement activities that increase the quality of care provided to patients.


• Identify areas for improvement and lead initiatives to enhance metric performance and patient outcomes.


• Support practices by timely processing of NCQA PCMH evidence submissions, reviewing submissions for completeness and accuracy. Reports any deficiencies or supporting documentation needs to site manager. Accurately tracks and saves all evidence as it is received.


• Performs duties in a professional manner while exhibiting a courteous and cooperative demeanor to co-workers, management, and the public.


• Maintains strict confidentiality, both internally (with Summit employees) and externally (with non-Summit individuals).


• Performs other appropriate duties, as assigned.

Education

High School Diploma or equivalent required, prefer additional vocational or college credits. Training and active licensure for LPN or RMA required.

Experience 

Minimum of 2 years of clinical experience in a primary care clinic, medical clinic or hospital required.

Minimum of 1 year of clinical quality experience preferred.

Certification/License

LPN or RMA with active registration in the state of TN or holding license in their state of residence if the state is participating in the Nurse Licensure Compact Law required; alternate licensed professional may be considered based on experience and overall qualifications as deemed necessary.