Job Description

Position Purpose: Ensure timely availability of accurate performance metrics, presented in a format understandable to various audiences

Oversees records retrieval for year-round and seasonal hybrid reviews occur in a timely fashion with a high degree of accuracy. Ensures a goal of 97% retrieval is met in a lean manner. Leverages technology to maximize outcomes, including automated faxing, file archives, etc. Maintains database and productivity metrics.

Oversees abstraction for year-round and seasonal hybrid reviews, ensuring over-reads are occurring regularly and scores meet policy requirements. Leverages technology to maximize efficiency and accuracy; maintains database and accuracy/productivity metrics.

Personally responsible for completion of non-HEDIS hybrid reviews (for example, AHCCCS hybrid reviews), including data collection and deliverable submission are of high quality, thorough, accurate and timely. Provides daily updates to leadership as needed.

Provides outcomes of year-round reviews (supplemental administrative data) in proper format for inclusion in monthly performance data sets. Collaborates with data warehouse team to ensure accurate, timely and complete submissions of hybrid data to data vendor, regulatory and accreditation bodies.

Builds a first-in-class quality analytics program using creative, innovative strategies and best practices. Builds infrastructure and lean processes to ensure sustainability and advance the department. Participates in QA of performance measure data on an ongoing basis; identifies gaps and concerns. Provide training, orientation, performance appraisals, hiring and disciplinary action of the retrieval and abstraction staff. Ensures team develops new competencies and are up-to-date on changes to performance measure specifications. Conducts audit kick-off meetings, daily project and trainings with auditors and records retrieval specialists as needed. Works with Marketing and Directors of Performance and Quality Metrics to identify trends in hybrid data that would benefit from provider outreach and education. Develops understandable materials and implements educational strategies to improve administrative and hybrid data capture.

Education: BachelorΓÇÖs degree, LPN, RN, CPHQ, CCS, CCS-P, RHIT, RHIA, CDEO, CPMA, CPC, CRC, CHCA or similar credential or equivalent professional experience.

Years of Experience: A minimum of 4 years of experience in healthcare quality focused roles that included medical record audits and/or performance metrics, i.e., HEDIS, Stars, CMS or similar

Specialized Knowledge:

-+ Ability to achieve required outcomes in a fast-paced environment, meet deadlines with a high level of accuracy

-+ Significant experience in quality measurement, HEDIS/Stars, interpretation of claims data, medical record review

-+ Strong computer skills, i.e., using various software, including intermediate Excel skills (sort, filter, reformat data, etc.)

-+ Strong analytic skills/ability to translate complicated data into useable information, including analysis of practice variation

-+ Successful experience managing complex projects beginning to end with accountability for outcomes, demonstrated organizational and project management skills to manage complex projects through effective planning, tracking, and resource allocation to meet business objectives and timelines

-+ Strong project management skills; self-directed

-+ Ability to generate creative solutions

Application Instructions

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