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Summary:
The responsibilities of this position demand, team player as well as a wide range of capabilities including: strategic planning and analysis skills; strong understanding of HEDIS and coding; management breadth to direct and motivate; highly developed communication skills; and the ability to develop clear action plans and drive process, given often ambiguous issues with numerous interdependencies. This position will facilitate any unresolved issues that remain as a result from following the standard process.
Collaboration between HEDIS Manager, Quality Director and Chief Medical Officer on improved innovation and process improvement. Work with the Quality Improvement team to collect member charts for review. Provide over site of abstracted records, quality assurance and data entry.
Facilitate communication between providers and health plan to optimize health and wellness, reduce inpatient admission, reduce re-admissions and improve medical stability in the patient population served. Responsible for the coordination of HEDIS data, gathering processes by evaluating quality and completeness of clinical documentation processes. Performs quality medical record reviews, assisting providers and staff in the improvement of clinical documentation, identifying trends and gaps in care, maintaining accurate records of review activities, ensures all data submitted to the health plan meets HEDIS technical specifications for medical records. Participates in the development and ongoing implementation of quality improvement activities by providing regular and ongoing provider/staff support and education.
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