Position Purpose:
Support the development and maintenance of quality improvement related projects and reporting. Respond to quality improvement inquiries.
Education/Experience:
Bachelor s degree in related field or equivalent experience. Certified Professional in Healthcare Quality (CPHQ) preferred. 3+ years of related experience.
License/Certification: Valid driver s license. Certified Professional in Health Care Quality (CPHQ) preferred.
Heavy chart monitoring and auditing of medical records
Monitor the production of quality results reporting; analyze, track and trend the reporting results and report them to management
Formulate and prepare ad-hoc and additional reporting requirements
Recommend, develop, and implement quality improvement plans with management
Train providers and staff in methodologies and tools of continuous quality improvement
Prepare for and participate in meetings with State agencies, providers, and stakeholders
Perform audits on to meet state and internal requirements
Performs other duties as assigned
Complies with all policies and standards
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
| Story Behind the Need |
Purpose: Support for HEDIS Season
Driving Need: Upcoming HEDIS Season-MY26
Team Culture: Hard Working and Collaborative
Position Justification: Temp staff for HEDIS season
Hiring Needs: No additional needs at this time, but that could change. | |
| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| Tasks:- Non-clinical staff who will be assigned to the Pends Team for HEDIS Season
- Pend staff will work and resolve pends in the provider portal system in order to secure medical records to close care gaps. Some duties include:
- Understanding the meaning of Pend codes and acting on them as appropriate
- Contact provider offices/medical groups to obtain missing medical records to complete the audit process.
- Create, Send and Track medical record requests
- Claims research
- Detailed tracking of pends status and daily activities
Describe the performance expectations/metrics for this individual and their team:- Individuals will be assigned a list of pends to work and resolve. Expectations are that the staff will complete their assigned pends by the end of each business day.
What makes this role unique:- Get to work collaboratively with a team of non-clinical and clinical staff working towards a common goal.
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| Candidate Requirements |
| Required: | Preferred: | |
| Required: | Preferred: | |
Years of experience required: At least 1 year of HEDIS Experience Preferred, or 1 year of Pends/Medical record request experience preferred. Willing to train the right candidate who does not have that experience.
Disqualifiers:
Additional qualities to look for: Detail oriented, punctual, reliable |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Knowledge of HEDIS Hybrid Measures |
| 2 | Ability to utilize technology proficiently (Pends Portals, Smartsheet, TEAMS, Excel, EMR s, QMRM) |
| 3 | Ability to stay organized and meet deadlines |
| Candidate Review & Selection |
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
| Projected Manager Candidate Review Date: | 1-2 days post shortlisting |
Type of Interviews:
| Teams- Cameras On |
| Required Testing or Assessment (by Vendor): | Computer skills test- Intermediate and above |
| Next Steps |
- Do you have any upcoming PTO?
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- Colleagues to cc/delegate
| Include Ramona Bouyer on all communications. She will be the supervisor in charge of the audit. |