Quality Coordinator (HEDIS)

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The primary function of the Quality Coordinator is to provide educational support and training to physicians, staff, and pharmacists virtually and at their practice locations to ensure high quality performance. Quality Coordinators engage providers on HEDIS, QARR and Medicare Advantage Star and Risk measures through quality improvement activities and data sharing.

Responsibilities include participating in initiatives across a broad array of clinical measures and health improvement activities. The position also completes provider outreach, audit, and education as needed to ensure members receive appropriate services.

The position will include telecommute and field-based work. Field work will require travel within the MetroPlusHealth service area.

• Maintain proficiency in MetroPlusHealth, Quality programs, HEDIS/QARR measures, Hybrid/Administrative manuals, MetroPlusHealth systems, Provider Electronic Medical Record systems and utilize this information to set and meet goals.
• Appropriately utilize provider educational tools to provide support and training to physicians, to include MetroPlusHealth VBP and P4P programs, supplemental and encounter data submission, Clinical Practice guidelines, medical record documentation, billing procedures and activities to improve the delivery of quality health care and service to MetroPlusHealth members.
• Review priority and hybrid measures meeting expectations for accuracy and records reviewed per day.
• Monitor provider/facility progress monthly; prepare and distribute monthly member gap in care reports and partner with office management and/or hospital contacts to initiate improvement through:
  • EMR system review of member gap lists to identify and share data collection opportunities, coding errors, documentation shortfalls, appointment timing issues.
  • Identify noncompliant members that require appointments and work with the providers to ensure timely member appointments are obtained.
  • Identify noncompliant member for the provider to refer to on-site facility health education programs or disease management collaborative as appropriate.
  • Develop and implement measure interventions in collaboration with provider quality and clinical staff.
  • Document all interventions and telephone encounters with providers in the appropriate system in accordance with established documentation standards for MetroPlusHealth.
• Participate or facilitate a participant in facility and community events that target MetroPlusHealth members.
• Routine on-site and virtual provider visits and/or meetings with quality and clinical staff to conduct education sessions regarding appropriate coding practices and medical record documentation practices.
• Review site coding practices to look for improvement opportunities.
• Conduct onsite retrieval of medical record documentation in support of annual MRR projects as needed, supports HEDIS/QARR.
• Facilitate request and review of charts with assigned provider in support of HEDIS & QARR annual medical record review projects.
• Other duties as assigned by the Senior Manager of Quality Management Operations.

• Associate's degree required; bachelor's degree preferred.
• 2 years' experience with medical records review working on HEDIS/QARR in a managed care or health plan setting; or
• An equivalent combination of training, educational background and experience in related fields and educational disciplines
• Ability to proficiently read and interpret medical records required.
• Knowledge of HEDIS specifications required
• Ability to travel within the MetroPlusHealth service area.
• Experience with relationship management
• Prior experience in Quality Improvement in a health care and/or Managed Care setting strongly preferred
• Knowledge of ICD-10 and CPT codes preferred
• Health Educator, RN, LPN, LMSW, LCSW, or Foreign Medical Graduate (FMG) preferred but not required

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical/Analytical Skills
• Knowledge of Microsoft Office applications including Word, Excel, PowerPoint, Access, and Visio
• Written/Oral Communications
• Ability to work in a team setting

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