Specialist, Quality

About the role

ArchWell Health’s Quality Specialist will be an integral part of the central services team. The Quality Specialist is responsible for the monitoring and pursuit of CMS STARS HEDIS measures, conducting central patient outreach calls, and partnering with market leaders for strategy and data sharing. This role will interconnect with operations, patient care teams and ArchWell Health members. This role will work across many payors over multiple markets and states in an outpatient senior-focused primary care setting.

Responsibilities

• Conduct enterprise and local strategies and initiatives for closing STARS gaps
• Medical record review for HEDIS® and HEDIS®-like measures (Focus On Care)
• Over-read of medical records
• Perform central patient outreach calls
• Meet regularly with Quality Leaders and Market Leaders to discuss any roadblocks, month to month progress and strategize center focused initiatives
• Build relationships and collaborate with the Pharmacy team and market leadership to ensure maximizing efforts when outreaching to patient for multiple STARS gaps
• Submit supplemental data to Health Plans as needed on a regular cadence
• Additional responsibilities and duties as assigned

Required Skills/Abilities

• Working knowledge of ICD-10, CPT, and HCPCS codes preferred
• Proficient with Microsoft Office Suite products including Word, Excel, Power Point, and Outlook, and Teams
• Willingness and ability to travel for on-site clinical education on occasion
• Demonstrated team building skills
• Excellent presentation, verbal, and written communication skills
• Ability to exercise use of independent judgement
• Sensitivity to the diverse needs of culturally diverse staff, patients, and communities
• Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately
• Embodies and serves as a role model of ArchWell Health’s Values:
  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Stay resilient
  • Always do the right thing

Education and Experience

• Associate degree or equivalent preferred
• Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) credentials preferred
• Experience with the CMS STARS program (HEDIS) preferred
• Experience with Electronic Medical Records, eClinicalWorks preferred