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About the Role

The Specialist, Quality will work closely with clinic staff to identify gaps in care, capture HEDIS documentation, perform chart audits, track patient engagement in care gaps, and notify clinics of time-sensitive care caps. They will also report low clinic engagement, opportunities for staff education, and reporting inaccuracies to the Director of Quality.

Responsibilities

• Identify and notify clinical staff of next steps needed to address open quality gaps.
• Submit documentation to payer portal to close quality gaps.
• Audit supplemental data to ensure results are compliant for identified measures.
• Educate staff and providers on HEDIS technical specifications.
• Resolve clinical staff Quality inquiries.
• Join daily huddles as needed to inform clinical staff of patients with outstanding time-sensitive measures.
• Collaborate with other departments on quality-specific projects to help reach quality goals.
• Actively participate as a team player to promote positive health outcomes for our patients.
• Be willing to take on additional tasks to support the overall success of the organization.

Requirements

• Bachelor's degree in healthcare administration or public health required.
• One of the following certifications, accompanied by 2+ years of experience in a value-based care setting (primary care or Medicare Advantage Plans preferred): Certified Medical Assistant, Certified Pharmacy Technician, Certified Nursing Assistant, NCQA certification.
• 4+ years of experience in a value-based care setting (primary care or Medicare Advantage Plans preferred).
• 2+ years of HEDIS or Risk Adjustment experience in supplemental data and chart reviews.
• Knowledge of CMS STARS program.
• Must have a basic understanding of billing and claims coding.
• Experience reviewing Electronic Medical Records.
• Intermediate level experience in working in Microsoft Excel, Word, and PowerPoint.
• Experience navigating payer portals.
• At least 1 year of experience utilizing medical terminology.

Skills

• Ability to work independently
• Strong problem-solving skills with the ability to identify solutions independently and know when to appropriately escalate complex issues
• Ability to multi-task
• Ability to work in fast-paced environments with changing priorities.
• Bilingual (English/Spanish) preferred

Location

• DFW area

Work Type

• Monday-Friday from 8-5PM CST

Experience Level

• 2+ years of experience in value-based care setting
• 4+ years of experience in value-based care setting
• 2+ years of HEDIS or Risk Adjustment experience
• 1 year of experience utilizing medical terminology

Education Level

• Bachelor's degree in healthcare administration or public health
• Certified Medical Assistant
• Certified Pharmacy Technician
• Certified Nursing Assistant
• NCQA certification

About the Company

• Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
• This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Equal Opportunity

• Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
• This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.