Quality Specialist

Job Description Summary

The Quality Specialist supports the Wellness & Preventive Management (WPM) Program, focusing on HEDIS measures, Annual Wellness Visits (AWVs), and care gap closure. This role is responsible for reviewing medical records, abstracting clinical data, identifying missing quality measures, and collaborating with providers and clinic staff to improve performance and patient outcomes.

Position Responsibilities

• Supports the Wellness & Preventative Management Program (WPM): HEDIS, Annual Wellness Visits, Appointments, and other Care Coordination tasks.
• Reviews assigned medical records in order to abstract clinical data elements for HEDIS reporting, e.g. results of laboratory tests, verification of hypertension and the most recent blood pressure reading.
• Collects medical record data and identifies needed improvements that impact HEDIS measures.
• Reviews noncompliant reports and flags patient’s charts with the missing measures.
• Requests quality data documentation from outside resources.
• Works closely with leadership to execute quality strategies.
• Manages the reports and monitors performance at group and providers level.
• Engages PCP and clinic staff in developing strategies to close quality gaps.
• Uploads HEDIS data to medical records and sends it to the health plan.
• Performs all other related duties as assigned.

Qualifications

• License/Registration/Certification: Preferred Certified Medical Assistant or Registered Medical Assistant.
• Education: Required: High School Diploma. Preferred: Bachelor of Sciences degree or in other related field, foreign medical graduate.
• Experience: Preferred: One year of experience in Care Coordination in outpatient setting or HMO, MSO or ACO.

Benefits

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retail retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions and more!