What are the responsibilities and job description for the Quality Performance Reviewer position at East Valley Community Health Center, Inc?
Founded in 1970, East Valley Community Health Center is a Federally Qualified Health Center (FQHC) who's services include providing personalized, affordable, high-quality medical, dental, vision and behavioral health care through a community-based network within the East San Gabriel Valley and Pomona Communities. Our staff practices patient-centered care by serving each patient with a personalized care plan that meets their individual needs. Our patients have access to support services that include, nutrition, health education, case management, pharmacy, lab, and x-ray at our health center locations. East Valley serves the health care needs of uninsured and underserved individuals and families throughout our 8 health center locations.
Our mission is to provide access to excellent health care while engaging and empowering our patients, employees, and partners to improve their well-being and the health of our communities.
The Quality Performance Reviewer is responsible for conducting daily review of medical charts to monitor and evaluate all relevant core processes and quality measures for compliance in accordance with federal, state, and health plans guidelines. This will include HEDIS and Medicare Advantage Star measure specifications. The Reviewer will ensure that workflow practices meet the professional standards of East Valley through the review of clinical documentation for completeness, accuracy, and compliance. The Reviewer will complete reviews within established timeframe and provide education to clinician and staff for documentation and quality improvement. The Reviewer may assist in developing corrective action plans as needed. The position may require travel within the different clinic sites.
MAJOR POSITION RESPONSIBILITIES AND FUNCTIONS:
- Conduct daily reviews of medical records to ensure all required elements are documented appropriately
- Provide feedback to providers and care team members of incomplete or inaccurate documentation
- Continuously monitor areas of deficiency are addressed appropriately and timely by providers and care team members to meet internal requirements and regulatory standards
- Provide consistent and timely reporting of provider documentation issues to management
- Collects and enters confidential information ensuring the highest level of confidentiality in all areas
- Assist in the development of provider clinical education tools using chart findings to improve accuracy in documentation
- Assist in conducting mock audits in preparation for regulatory and health plan audits
- Maintain understanding and ability to interpret current regulatory agencies and health plans requirements related to medical record
- Ability to use independent judgement related to medical record review
- Other duties as assigned
POSITION REQUIREMENTS AND QUALIFICATIONS:
- Minimum 2 years’ experience with medical record review working in a health care setting
- Working knowledge of HEDIS and Medicare Advantage Star measures
- Experience with EMR systems, preferably NextGen
- Ability to be assertive and tactful when communicating with medical staff
- Knowledge of all current Windows based programs.
- Ability to multi-task and prioritize daily workload
- High Level of verbal and written communication
East Valley offers a competitive salary, excellent benefits to include: medical, dental, vision, and 403b retirement plan. We match the first 6%of employee contributions, and full vesting starts immediately. You will also enjoy work-life balance with paid time off and paid holidays throughout the year.
Please apply to this position with your current resume.
Principals only. Recruiters, please do not contact this job posting.
EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit Retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.
