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Quality Team Lead (North Fort Myers)

Summary
The Quality Team Lead is responsible for HEDIS initiatives, associated revenue and other Pay for Performance Projects. This position includes ongoing quality improvement activities to assure the organization's quality reporting programs are implemented and meet all requirements. The Quality Team Leads responsibilities are considered critical to MPG operations. Developing timelines for multi project management are essential for this position and coordination with a multi-disciplined team of employees will require effective communication and professionalism across organizational boundaries.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Organizes and supervises medical record reviews prior to annual wellness visits and other identified visits to determine maximizing revenue through appropriate coding, billing and compliance with quality metrics.
Meet insurance carrier quarterly and annual quality measures as outlined in contracts and communications, i.e. Preventative screenings, care coordination, medication adherence and reconciliation, immunizations, chronic disease quality factors, care of older adults. Current performance measurement is "Stars" and "5" is the goal.
Support continuum of patient care by identifying patients with gaps in care or in need of quality metrics reporting prior to each annual wellness visit and other visits, as necessary, to insure HEDIS code capture.
Responsible for education, education tools and/or educates providers, office staff, care team and Quality Team on HEDIS and other contract-mandated quality metrics specifications, pay for performance measurement and medical record review criteria to meet goals.
Supports the HEDIS medical record chase by providers for optimum HEDIS and quality metric reporting using EMR and Revenue Reporting, Medicare Advantage and ACO quality databases, gap reports and carrier scorecards.
Document and trend findings, performance improvement initiatives, and compliant actions to maximize quality revenue.
Generally works independently under the supervision of the Director of Quality Programs.
Facilitates and coordinates reporting to leadership within the organization as requested.
Communicates to Supervisor and I.T. Department regarding defects in the reporting system or database, suggested performance improvement tactics, and tracks through to completion to insure revenue capture of quality metrics for organization.
Supervises staff in HEDIS/ACO chart reviews and quality initiatives using MPG policy and procedure.
Clear, concise and professional communication to varying audiences dependent on the project and its goals.
Time management, meetings, travel and deadlines may require hours outside standard 40 hour work week.
Other assignments as directed by Supervisor.
Supervisory Responsibilities
Directly supervises ten or more employees in the Quality department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Adaptability Maintaining effectiveness in varying environments and with different tasks, responsibilities, and people.
Analysis/Problem Assessment Securing relevant information and identifying key issues and relationships from a base of information; relating and comparing data from different sources; identifying cause-effect relationships.
Communication - Expressing ideas effectively in individual and group situations (including nonverbal communication); adjusting language or terminology to the characteristics and needs of the audience. Good listening skills.
Compassion - The responsibility to put a patient's or person's interests first, including the duty not to harm, deliver proper care, and maintain confidentiality.
Compliance - Employee has satisfactory completed employers required compliance training.
Employee is able to demonstrate an understanding of employers Code of Conduct.
Dependability - Meets commitments, deliverables, deadlines, work independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, and meets attendance/punctuality requirements.
Follow-up - Establishing procedures to monitor the results of delegations, assignments, or projects; taking into consideration the skills, knowledge, and experience of the assigned individual and characteristics of the assignment or project.
Initiative - Making active attempts to influence events to achieve goals; self-starting rather than accepting passively; taking action to achieve goals beyond what is required; being proactive. Practices self-development.
Integrity - Maintaining and promoting social, ethical, and organizational norms is conducting internal and external business activities.
Judgement/ Problem Solving - Recognizes problems and responds, systematically gathers information, sorts through complex issues, seeks input from others, addresses root cause of issues, makes timely decisions, can make difficult decisions, uses consensus when possible, and communicates decisions to others.
Patient Service Orientation - Proactively developing patient/customer relations by making efforts to listen and understand the customer and their needs (both internal and external); anticipating and providing solutions to customer needs; giving high priority to patient/customer satisfaction. Ensures appropriate follow up and is their advocate in determining solutions. The employee uses a variety of communication techniques to effectively express thoughts and ideas and to understand or influence.
Practical Learning - Assimilating and applying, in a timely manner, new job-related information that may vary in complexity.
Quality Orientation/ Attention to detail - Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems, owns/acts on quality problems.
Results Driven& Execution - Accountable for meeting or exceeding individual and/or department goals and objectives. Committed to producing results that will achieve company objectives. Sets priorities and organizes time to meet or exceed goals, follows up, and takes personal responsibility for results whether they are positive or negative. Team work/ Collaboration - Working effectively with team/work group or those outside formal line of authority (e.g., peers, senior managers) to accomplish organizational goals; taking actions that respect the needs and contributions of others; contributing to and accepting the consensus; subordinating own objectives to the objectives of the organization or team. Listens to others and values opinions.
Technological /Professional knowledge - Having achieved a satisfactory level of technical and professional skills/knowledge in job-related areas; keeping abreast of current developments and trends in area of expertise.
Work Standards - Setting high goals or standards of performance for self, direct reports, others, and the organization; being dissatisfied with average performance; self-imposing standards of excellence rather than having standards imposed by others.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Preferred CMA, LPN, or RN
Education and/or Experience
Bachelor's degree from four-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience. Position requires flexibility in work hours, multi-tasking, and excellent computer skills.
Language Skills
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Mathematical Skills
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Reasoning Ability
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills
To perform this job successfully, an individual should have proficient knowledge of Microsoft Excel Spreadsheet software; Microsoft Word Processing software, Outlook and ADP Payroll systems. Knowledge of Computers, Fax, Portals, Uploading, Downloading, Athena or other Electronic Medical Record System.
Certificates, Licenses, Registrations
Physician professional coding and billing certification preferred.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance and talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate depending on business activity of the office.



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