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Quality Improvement Specialist II

Baystate Health

Springfield, MA

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JOB DETAILS
SALARY
$66,081–$75,982 Per Year
SKILLS
Analysis Skills, Auditing, Billing, Business Strategy, Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Clinical Data, Clinical Data Collection, Clinical Medicine, Clinical Study Publications, Clinical Validation, Code Reviews, Communication Skills, Current Procedural Terminology (CPT), Customer Relations, Data Entry, Diagnosis-Related Group (DRG), Documentation, Documentation Standards, Driver's License, Electronic Medical Records, Employee Relations, Establish Priorities, Healthcare Common Procedure Coding System (HCPCS), Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Quality, ICD-10, Incentive Programs, Industry Standards, Mail Processing, Materials Testing, Medical Coding, Medical Office, Medical Record System, Medical Records, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Word, National Committee for Quality Assurance (NCQA), Operational Improvement, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Quality Assurance, Quality Management, Regulations, Risk, Standards of Care, Strategic Planning, Support Documentation, Training/Teaching, Travel Planning, Willing to Travel, Writing Skills
LOCATION
Springfield, MA
POSTED
30+ days ago
Summary:


Location : Hybrid work opportunity; 3 days on site; travel to offices required.


Schedule : Fulltime; Monday-Friday; 8hrs per day; 6a-5p (flexible start time)


On call: As needed for AD HOC scheduling flexibility during regulatory reporting seasons.


_Purpose_ _of the Job_


The Quality Improvement Specialist II contributes to the overall success of the Quality and Accreditation Department by ensuring specific individual goals, plans, and initiatives are executed / delivered in support of the team’s business strategies and objectives. The Quality Improvement Specialist II is responsible for performing medical record reviews and clinical data abstraction services in support of Health New England’s clinical quality improvement operations. This valuable work provides crucial qualitative and quantitative insight to the development and execution of clinical quality and health equity strategic plans. This position uses knowledge of paper and electronic medical records as well as medical coding guidelines, HEDIS technical specifications, and standards of clinical care to complete comprehensive clinical abstractions, assists in insights analysis and translates areas of opportunity into provider office trainings. Through these efforts, we can work to improve the healthcare quality our community.


_Accountabilities_


+ Champions a customer focused culture to deepen client relationships andleveragebroader Health New England’s relationships,systemsand knowledge.


+ Understand how Health New England’s culture and the CX Promise should be considered in day-to-day activities and decisions.


+ Actively pursues effective and efficient operations of their respective areasin accordance withHealth New England’s Values, its Code ofConductand the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct.


+ Championsahigh performanceenvironment and contributes to an inclusive work environment.


Medical Record Retrieval – 10%


+ Manage individual list of records for retrieval outside of direct electronic medical records


+ Directly outreach to offices and coordinate record collection


+ Provide provider offices effective communication on document requirements and process


+ Report out to Quality Improvement Specialist II or Quality Accreditation Manager weekly on retrieval progress


+ Manage one-off,subsequentmedical record requests through the pursuit process


+ Process files for abstraction once received


+ Maintain frequent bidirectional feedback with offices to ensure effective communication


+ Work to develop effective relationships with practice staff


Medical Record Review and Abstraction–50%


+ Develop andmaintaina SME level of knowledge on HEDIS medical record review measures


+ Usingmedical record and clinical qualityexpertise, performs HEDIS clinical abstraction in both directelectronic medical record (EMR) and physical medical records to auditprovider compliance with HEDIStechnical specifications


+ Reviews medical records and interprets clinical documentation for patient compliance and delivery of the standard of care during the HEDIS project, Quality improvement projects, and Provider incentive programs


+ Serves as the lead for EMR HEDIS abstraction coding audits


+ Functions as a resource for staff using NCQA certified HEDIS medical record review abstraction software


+ Assistsin the on-going strategic development of Health New England’s medical record review process for all functional areas


+ Perform off-regulatory-season reviews to support strategic areas of focus


Application of Medical Record Review Findings – 20%


+ Identifyareas of opportunity in either the clinical delivery or clinical documentation


+ Develop provider office focused trainings based of the selected findings


+ Communicates and coordinates reviews with physician office staff and distributes correspondence related to the review


+ Gathers documentation to support annual validation audits


+ Assistsin the annual development of the larger Quality Improvement and Accreditation strategy based of medical record review findings


Audit Preparation, Submission and Development Strategy– 20%


+ Assistin general audit preparation and submission activities


+ Prepare medical record review training materials and InterraterReliability testing


+ Perform quality assurance audits to ensure clinical abstraction accuracy


+ Manage accountability over relevant staff members to ensure all work is completed


+ Ensure completeness of all necessarymedical record documentation for audit submissions


+ Assistsin knowledge support of HEDISmedical record review tool


_Education / Experience / Other Information_ _(include only those that are specific to the role)_


Bachelor’s degree required with more than five years of clinical quality data review, medical record abstraction, risk adjustment coding or an equivalent combination of education and experience. In addition:


+ Certified Professional Coder (CPC-H, COC, CIC, or CRC) or Certified Coding Specialist (CCS-P or CCS)required


+ Minimum of 2 years in coding, billing or clinical settingrequired


+ Experience with HEDIS technical specifications preferred


+ Ability to read and interpret clinical documentation as detailed in the medical record for bothquality of carestandards and medical coding purposes


+ Demonstrated experience with ICD-10 Coding Guidelines and Documentation Standards, CPT, DRG and HCPCS coding systems


+ Experience with industry standard Electronic Medical Record systemsrequired


+ Knowledge of clinical data collection,analysisand data presentation methods


+ Skilled with Microsoft Office Suite (Word, Excel, PowerPoint, Access)


+ Ability to work and make decisions independently, set priorities and manage a shiftingwork load


+ Travel to provider practice to conduct medical record retrieval or onsite abstraction


+ Must have a valid driver’s license in good standing


+ Excellent verbal, written and presentation skills


+ Excellent organizational skills


+ Problem resolution skills


_Working Conditions_


_Works in a standard office-based environment with_ _long periods_ _of data entry, sitting, viewing computer_ _monitors_ _and utilizing virtual communication tools_ _._ _Pre-Planned travel will be_ _require_ _d_ _for_ _the collection of medical records_ _._


Education:


Bachelors Degree (Required)


Certifications:


Compensation


Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.


Minimum - Midpoint - Maximum


$66,081.00 - $75,982.00 - $89,876.00


Equal Employment Opportunity Employer


Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

About the Company

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Baystate Health