Quality Assurance Specialist (North Fort Myers)


The Quality Assurance Specialist 1 is responsible to assist the department in ongoing HEDIS collection and Quality Improvement Activities. The position reports to the Quality Assurance Manager. This position includes ongoing quality improvement activities to assure the organization's quality programs are implemented and meet all requirements for successful Hedis and quality metric reporting to contracted carriers.

Job Standards:

1. Assists quality team in performing chart reviews for scheduled visits re contracted quality metrics and GPRO reporting.

2. Support continuum of patient care by identifying patients with gaps in care or in need of quality metrics reporting prior to scheduled identified visits.

3. Provides feedback to Quality Assurance Manager of areas of opportunity for HEDIS and other contract-mandated quality metrics specification and pay for

performance measurements, and medical record review criteria for GPRO.

4. Supports the reporting of HEDIS quality metrics chart review and creation of quality scrub encounter.

5. Works independently under the supervision of a Quality Assurance Manager and cohesively with Quality Team.

6. Supports coding team in preparation of coding summary spreadsheets, communications and follow up with providers, schedules reviews and builds rules in

Athena to capture.

7. Maintain department supplies.

8. Ability to use multiple insurance and quality data bases to support successful Care Gap closure for MPG patients.

9. Assist department with claims work lists related to coding and quality initiatives.

10. Exhibits strength in verbal and written communication and prioritization of assignments.

11. Recognizes the confidentiality of the work assignments and department assignment.

Millennium Physician Group
https://millenniumphysician. applicantpro. com

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