Quality Measures Specialist

Responsibilities

• Reviews ambulatory clinical documentation to ensure accurate depiction of patient acuity, including compliant documentation supporting HCC, ICD-10, and medical necessity.
• Demonstrates knowledge of CMS coding guidelines to improve the overall quality and completeness of patient medical records.
• Pulls data from multiple sources to produce reports related to ambulatory clinical documentation, quality, and value-based care.
• Collaborates with quality and multidisciplinary teams to develop strategies for improving clinical documentation quality and patient risk adjustment.
• Communicates professionally and respectfully with providers, practice staff, quality leaders, medical directors, and compliance specialists.
• Led and collaborates on special projects around quality metrics with medical directors, leadership, practices, and stakeholders.
• Provides education to providers and staff regarding value-based care and the importance of accurate, specific, and complete clinical documentation.
• Participates in meetings, committees, and educational programs as needed.

Requirements

• Knowledge of chronic and acute disease conditions, management, and treatment
• Knowledge of value-based care
• Understanding of care gap closure and value-based care
• Understanding of Healthcare and clinical operations, medical terminology, and medical reporting
• Ability to communicate effectively with providers
• Capacity to collaborate with professional colleagues as necessary to ensure quality care
• Able to interpret, adapt and apply guidelines and procedures
• Excellent communication skills; both verbal and written
• Solid problem-solving skills, identifying, analyzing and effectively solving problems, utilizing critical thinking
• Capability to multitask
• Able to work independently
• Able to work in multiple systems, extract data and create reports
• Adaptability and flexibility, able to function in a fast-paced environment
• Strong computer skills including previous experience with an EMR and Microsoft Office, and reporting software
• Knowledge of data analysis and statistical methods

Qualifications

• 3+ equivalent experience in healthcare system or medical practice
• Certified Billing and Coding Specialist (CBCS)
• American Association Medical Assistants (CMA)
• OR Clinical Medical Assistant Certification (CMAC)
• OR Registered Medical Assistant (RMA)
• OR National Certified Medical Assistant (NCMA)
• OR Certified Clinical Medical Assistant (CCMA)
• OR Nationally Registered Certified Medical Assistant (NRCMA)
• Certified Research Coordinator (CRC)
• OR Certified Professional Coder (CPC)
• OR Certified Outpatient Coder (COC)
• OR Licensed Practical Nurse (LPN)

Skills

• Knowledge of chronic and acute disease conditions, management, and treatment
• Knowledge of value-based care
• Understanding of care gap closure and value-based care
• Understanding of Healthcare and clinical operations, medical terminology, and medical reporting
• Ability to communicate effectively with providers
• Capacity to collaborate with professional colleagues as necessary to ensure quality care
• Able to interpret, adapt and apply guidelines and procedures
• Excellent communication skills; both verbal and written
• Solid problem-solving skills, identifying, analyzing and effectively solving problems, utilizing critical thinking
• Capability to multitask
• Able to work independently
• Able to work in multiple systems, extract data and create reports
• Adaptability and flexibility, able to function in a fast-paced environment
• Strong computer skills including previous experience with an EMR and Microsoft Office, and reporting software
• Knowledge of data analysis and statistical methods

Benefits

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule

• Full time
• Shift Day

Pay

$20.23 - $98,136.64

Address

500 E Central Ave
Winter Haven, FL 33880