Location
Winter Haven, FL | United States
Job description
General Summary of Duties: The position is responsible for providing critical analyst support to the Quality Management Department by working on HEDIS reports from insurance companies and their portals. Responsibilities include working HEDIS Measure spreadsheets, Quality Metrics along with the knowledge to perform onside medial record reviews and medical record collection through Electronic Medical Records to support optimum MRA/HEDIS and quality metric reporting. Works with Physician team to ensure ordering of HEDIS measures is performed.
Examples of Duties: (This may not include all of the duties assigned)
- MRA/HEDIS data collection, analysis, and reporting to create Attestations, PAF for physicians
- Phone calls to patients for scheduling or education on HEDIS Measure while documenting a telephone call in HER.
- Work with Physicians and Staff to assist Chronic Care Members with needs.
- Update Excel Spreadsheet with QM Comments for tracking and weekly reports to Director
- Eye Screening Center to perform Fundus Photos on Diabetic Patients. Complete photo, upload to interpreting MD bill properly, and submit report to insurance companies to close HEDIS Measure.
- Analysis and evaluate various sources of data to improve quality and further the goals and objectives of the organization.
- Research best practices, national and regional benchmarks, and industry standards of care.
- Develop and produce reports that monitor and benchmark, utilization, and other quality and performance indicators.
- Monitor for adverse trends, recommend modifications, and corrective action.
- Perform medical record reviews, data collection, chart abstractions, and reporting and analysis.
- Coordinates and performs medical record reviews and medical record collection for each provider to support HEDIS and quality metric reporting.
- Provide analytical support to internal departments regarding quality improvement activities.
- Participate in relevant committees and work groups; make presentations, prepare reports, data, or other materials for presentation.
- Monitor patients in programs offered and work with primary care physicians to ensure overall health needs of patients.
- Perform all other duties assigned.
Performance Requirements:
Education: High School Diploma or GED required.
Experience:
- 1-2 years of experience with healthcare; managed care or HEDIS data analysis.
- Computer experience required.
- CMA, LPN, RN preferred, but not required.
Certificate/License:
Certified Coder, CMA, LPN, RN preferred, but not required if experienced.
Bond Clinic is a Drug Free Workplace and an Equal Opportunity Employer. Bond Clinic will provide reasonable accommodation to complete the online application consistent with applicable law. If you require an accommodation, please contact Human Resources.
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