The Quality Specialist is responsible for providing support for quality assessment and performance activities that include HEDIS, quality monitoring, evaluation and facilitation of quality related projects. Additionally, the Quality Specialist participates in company-wide quality initiatives.
Principal responsbilities include:
· Assist in the design and the execution of quality initiatives and projects.
· Support and participate in Year Round HEDIS initiatives and activities
· Process and manage member and provider communications as appropriate to each project.
· Coordinate and participate in the collection of data from medical records, logs, databases and error reporting systems that support quality initiatives.
· Utilize quality methodology in training departments and multi-disciplinary teams.
· Under direction, conduct concurrent and retrospective focused studies to evaluate and analyze targeted areas of performance.
· Participate in process improvement initiatives, and other special initiatives.
· Promote positive inter-department cooperation and participate in applicable committees or task forces. Demonstrate a positive behavior in identifying and resolving complex or out of policy operation problems.
· Comply with all regulatory and licensing agency requirements and promptly inform the applicable person(s) of changes and updates.
· Report and facilitate changes in standards of care as necessary.
· Perform other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
· Data collection, measurement, maintenance, and analysis.
· Report and presentation development to support regulatory submissions.
· Coordinate and consult with Alliance departments on activities and projects.
· Keep abreast of healthcare industry best practices and managed care regulatory requirements.
Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls
· Constant sitting and working at desk.
· Constant data entry using keyboard and/or mouse.
· Frequent use of telephone headset.
· Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
· Frequent lifting of folders and various other objects weighing between 0 and 30 lbs.
· Frequent walking and standing.
· Occasional driving of automobiles.
EDUCATION OR TRAINING EQUIVALENT TO:
· Bachelor’s degree or equivalent in health sciences or related field.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Two years of relevant healthcare experience.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes.
· Strong communication and presentation skills, training/meeting facilitation skills a plus.
· Solid relationship building and interpersonal skills.
· Excellent writing, research, analytical, and time management skills.
· Excellent coordination skills, including multi-tasking and setting priorities on work assignments.
· Ability to organize and coordinate various activities involved in a research, collaborative and demonstration project.
· High degree of independence, flexibility, initiative and commitment.
· Ability to work effectively with diverse population, both internally and externally.
· Solid critical thinking and problem-solving skills.
· Ability to utilize sound judgment and promptly report potential risks.
· Ability to work in a fast paced, patient-service oriented environment.
· Demonstrate ability to promote quality improvement through development and maintenance of standards.
· Must handle PHI and maintain confidentiality at all levels.
·Proficiency in Windows including Microsoft Office suite including Word, Excel, and PowerPoint.