Oakhurst Medical Centers Inc

  • Healthcare Quality Analyst

    Job Locations US-GA-Stone Mountain
    Posted Date 1 month ago(6/18/2018 3:41 PM)
    ID
    2018-1231
    # of Openings
    1
    Category
    Administrative/Clerical
  • Overview

    The Healthcare Data Quality Analyst is responsible for monitoring and improving the financial results of the center’s shared savings and quality payment programs. Analysis of ongoing measurement data, reporting, and information dissemination with a focus on improving financial outcomes. The Healthcare Quality Data Analyst will work with internal and external teams to improve clinical quality scores. This position will participate in meetings with providers to find new ways to collaborate; ensuring that the collective approach is patient and provider centered. This position will also meet with insurance plans to review monthly quality and financial results and work with each plan collaboratively to improve the centers quality and financial results.

    Responsibilities

    • Acquire and maintain expertise about the Medicare/Medicaid and Accountable Care Organizations (ACO) Quality Payment Program including future impacts to the organization.
    • Assists providers in understanding the Medicare/Medicaid quality Healthcare Effectiveness Data and Information Set (HEDIS) STARS program as well as CMS Hierarchical Condition Category (HCC) Risk Adjustment program as it relates to payment methodology and the importance of proper chart documentation of procedures and diagnosis coding.
    • Perform chart reviews to ensure Medication Adherence compliance and resolve any barriers for non-compliance.
    • Identify gaps for quality improvement and use Quality Improvement (QI) methodology to improve outcomes.
    • Verify accuracy of quality data reports and combine information to focus attention on key information while providing necessary explanations for financial and operational leaders.
    • Identifies statistical trends, and potential issues in patient care and services. Works collaboratively with physicians and financial and operational leadership on developing corrective plans, and monitoring their effectiveness.
    • Develop, implement, and monitor processes, interventions, and activities to improve HEDIS STARS measures to be 4 STARS or higher.
    • Report and summarize provider group performance and center performance as requested or required by the health plans to demonstrate how this impacts the center from the quality and financial standpoint.
    • Analyze and evaluate provider group structure and characteristics, office operations, and personnel to identify the most effective approaches and strategies.
    • Identify barriers to achieving targeted outcomes and report to financial and operational leadership.
    • Develop solution-based, user-friendly initiatives to support practice success.

    Qualifications

    • Minimum Associate’s Degree in a healthcare field or equivalent preferably in Health Information Management, a clinical field, or healthcare informatics required.
    • Bachelor of Science Degree in information technology, statistics, mathematics, health sciences, or related field preferred.
    • Thorough knowledge of CPT/ICD-10 codes and clinical documentation.
    • Strong financial analytical background and medical record content.
    • A self-starter who can manage his or her own daily workload, operate well under pressure, and balance competing priorities.
    • Excellent communication, organizational, and customer service skills.
    • Proficiency in Microsoft Office programs.
    • Excellent phone etiquette.

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