Quality Specialist FT, Day

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose:  Inspire health.  Serve with compassion.  Be the difference.

• Supports large network providers (multi-provider sites, hospital/facility-based practices) in the review and analysis of quality improvement programs related to provider quality reporting. Visits providers in their offices (in the field) and provides associated customer service/support for the ACO/CINs' quality programs. Facilitates, develops and coordinates best practice and quality improvement activities to advance the transformation of care across the ACO and other applicable providers in the CCI client base. Develops knowledge in one or more areas that may include: CMS quality programs (MSSP, PQRS, MIPS), NCQA programs (PCMH certification and recognition standards), and other best practice care models, policies, processes and application requirements. May initiate, analyze, audit, or submit CMS quality reporting and/or NCQA applications submissions, and audits for CCI clients under the supervision of Senior Quality Specialists. May educate and instruct appropriate leaders and practice staff in their responsibilities related to quality programs under the supervision of Senior Quality Specialists. Escalates issues, questions to Senior Quality Specialists. Provides outstanding customer service to CCI clients and the providers in their networks/delivery systems. 

• Supports the development of and delivers organized training (small/large groups) and webinars (live and recorded) related to the ACO/CIN quality programs.

• Provides feedback to the data operations, data quality, and performance management teams in response to what is learned in the field. Provides feedback to the data operations, data quality and performance management team regarding new product development, design, and implementation.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - Bachelor's degree in Health Sciences, Social Work, Public Health, Biology, Chemistry or related field of study.

• Experience - No experience required. One (1) year healthcare service experience including nursing, office/practice management, medical assistant, medical/claims coding, EHR/EMR data input or data analytics in another field/industry preferred.

In Lieu Of

• In lieu of education and experience noted above, an equivalent combination of work/academic experience may be considered (i.e., four years of related work experience or Associate degree in a healthcare or technical field and two (2) years of experience in a healthcare field or a Masters degree in related field of study)

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Ability to remains current and knowledgeable about physician/provider/practice quality reporting for accountable care organizations and clinically integrated networks

• Knowledge of healthcare quality and process improvement experience preferred

• Knowledge of databases, statistics and mapping software/tools preferred