Hedis Quality Coordinator - Medford

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

We are looking for a HEDIS Quality Coordinator. If you are passionate about your work, eager to have fun; and motivated to be part of a fast-growing organization in Medford, Oregon, then you should consider joining our team.

Overall Purpose:

The HEDIS Quality Coordinator supports HEDIS quality gap closures and supports the regional quality team under the direction of the Quality Manager. Through provider and patient engagement, the HEDIS Quality Coordinator assists patients and affiliates in ensuring HEDIS quality gap closure, documentation, and submittal to health plan. This position provides telephonic outreach to patients to provide patient education and engagement regarding annual screenings, medication adherence, and appropriate follow up with primary care provider.

This position has access to various electronic health records to data mine quality measure data and collating that data for submittal to the health plan. This position, depending on education and experience, may directly interact with patients in their home to ensure appropriate HEDIS measures are closed such as obtaining patient blood pressure, diabetic eye exams, and distribution of screening materials.

The Quality Management team ensures compliance with policies and procedures as dictated by but not limited to the following: Centers for Medicare and Medicaid Services (CMS), the National Committee on Quality Assurance (NCQA), and respective health plans.

Essential Duties and Responsibilities:

• Participates in data collecting through medical record and claims surveillance

• Responsible for reviewing data collected to confirm gaps in care are captured

• Conduct data entry and maintain appropriate documentation and tracking for quality initiatives

• Conducts telephonic outreach to specified patients on priority lists for any outstanding care gaps and schedule accordingly

• Educating patients on procedures that are being scheduled/performed and the reason for performing them

• Supports and educates affiliate practices on optimizing HEDIS gap closure

• Depending on education and experience - conduct in home HEDIS gap closure for select measures such as blood pressures, diabetic eye exams, point of care hemoglobin a1c testing, distribution of colorectal screening kits

Knowledge, Skills, and Abilities:

• Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA

• Knowledge of federal, national, state, and health plan regulatory requirements, as well as managed care and health plan standards

• Strong analytical, critical thinking, and problem-solving skills

• Data mining experience

• Excellent interpersonal and communication skills with patients, providers, internal and external stakeholders

• Excellent organizational and time management skills

• Depending on education and experience - demonstrate knowledge of vital signs and other clinical skills related to direct patient care for quality gap closure

Minimum Education and Experience:

• High school diploma or GED equivalent

• Current CPR

• 2+ years in healthcare environment

• Experience with Microsoft Word, Excel, Power Point, Outlook

• Experience in Electronic Health Records

• Medical terminology knowledge

Preferred Education and Experience:

• Associate degree in related field or equivalent experience

• 3+ years health care related experience, managed care, or health insurance experience

• Medical Assistant certification and/or Pharmacy Technician certification

• CPHQ (Certified Professional in Healthcare Quality)

• Experience with CPT II codes