HEDIS Quality Practice Advisor (Remote)

Competitive Compensation & Benefits Package!  

Position eligible for – 

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs

See attachment for additional details. 

Office Location:  Negotiable for any of our office locations; Remote Option Available 
Projected Hiring Range:  Depending on Experience
Closing Date: Open Until Filled

Primary Purpose of Position:   

The primary purpose of the Quality Advisor position is to oversee and facilitate the annual HEDIS project and ongoing supplemental data collection and abstraction processes. This role involves establishing strong relationships with large physician practices, Independent Physician Associations (IPAs), and other healthcare providers to ensure comprehensive data collection. The Quality Advisor educates and supports providers on National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment requirements, with a particular focus on accurate documentation and coding practices. They play a pivotal role in coordinating appointments, conducting chart reviews, and overseeing data abstraction to ensure compliance with HEDIS standards. Through data analysis and trend identification, the Quality Advisor collaborates with providers to identify areas for improvement and implement targeted interventions to enhance performance and close care gaps. Overall, the Quality Advisor's primary purpose is to drive quality improvement initiatives by facilitating accurate data collection, abstraction, and reporting processes in alignment with HEDIS requirements. 

Role and Responsibilities:   

 1. HEDIS Project Management: Oversee and facilitate the annual HEDIS project, including coordinating data collection efforts, ensuring adherence to project timelines, and managing the overall process. 

2. Supplemental Data Collection and Abstraction: Coordinate ongoing supplemental data collection and abstraction activities to support HEDIS reporting requirements. This may involve conducting chart reviews, extracting relevant data, and ensuring accuracy and completeness of information. 

3. Provider Education and Support: Educate and support healthcare providers on HEDIS measures, risk adjustment requirements, and documentation standards. Provide guidance on appropriate coding practices and documentation improvement strategies. 

4. Appointment Coordination: Coordinate appointments with healthcare providers for data collection, chart reviews, and quality improvement activities. Ensure efficient scheduling and communication to maximize provider participation. 

5. Data Analysis and Trend Identification: Analyze HEDIS and supplemental data to identify trends, performance gaps, and areas for improvement. Use data-driven insights to develop targeted interventions and strategies for quality improvement. 

 6. Quality Improvement Interventions: Collaborate with healthcare providers to develop and implement quality improvement interventions based on identified needs and performance metrics. Provide ongoing support and guidance to facilitate improvement efforts. 

7. Gap Closure Strategies: Work with providers to develop and implement strategies for closing care gaps and improving performance on HEDIS measures. Monitor progress and adjust interventions as needed to achieve desired outcomes. 

8. Documentation and Reporting: Ensure accurate documentation of quality improvement activities and reporting of HEDIS data. Prepare reports and presentations to communicate findings, progress, and outcomes to internal stakeholders and regulatory agencies as required. 

9. Provider Relationship Management: Build and maintain positive relationships with healthcare providers, including large physician practices, IPAs, and other stakeholders. Serve as a trusted resource and liaison for quality-related initiatives and concerns. 

10. Compliance and Regulatory Adherence: Ensure compliance with regulatory standards, including State and Federal requirements for HEDIS reporting and documentation. Stay informed about changes in regulations and guidelines and ensure organizational compliance. 

11. Continuous Improvement: Identify opportunities for process improvement and optimization in data collection, abstraction, and quality improvement practices. Implement changes and best practices to enhance efficiency and effectiveness. 

12. Member Engagement Support: Collaborate with member outreach teams to support member engagement efforts related to quality improvement initiatives. Provide input on strategies for engaging members in preventive care and health promotion activities. 

Overall, the Quality Advisor plays a critical role in driving quality improvement efforts within the organization by overseeing HEDIS projects, coordinating data collection and abstraction activities, providing support to healthcare providers, and implementing interventions to improve performance on quality measures. 

Knowledge, Skills and Abilities:  

Knowledge: 

1. Comprehensive understanding of National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment methodologies. 

2. Knowledge of healthcare quality improvement principles, methodologies, and best practices. 

3. Familiarity with medical terminology, coding systems (e.g., ICD-10, CPT), and healthcare documentation standards. 

4. Understanding of healthcare regulations and compliance requirements related to quality reporting and documentation. 

5. Knowledge of data collection, abstraction, and analysis techniques, including proficiency in data management tools and software. 

Skills: 

1. Strong analytical skills, with the ability to interpret complex data sets, identify trends, and draw meaningful conclusions. 

2. Excellent communication skills, both verbal and written, with the ability to effectively convey technical information to diverse audiences. 

3. Organizational and project management skills, including the ability to prioritize tasks, manage competing priorities, and meet deadlines. 

4. Collaboration and interpersonal skills, with the ability to build rapport and establish effective working relationships with healthcare providers and internal stakeholders. 

5. Problem-solving skills, with the ability to proactively identify issues, develop solutions, and implement corrective actions to address quality-related challenges. 

Abilities: 

1. Ability to work independently and as part of a team, demonstrating initiative, self-motivation, and a proactive approach to quality improvement initiatives. 

2. Adaptability and flexibility to navigate changing priorities, organizational dynamics, and evolving regulatory requirements. 

3. Attention to detail and accuracy, with a commitment to ensuring data integrity and compliance with quality reporting standards. 

4. Customer service orientation, with a focus on meeting the needs of healthcare providers and supporting their quality improvement efforts. 

5. Ability to drive results and achieve measurable outcomes in quality improvement initiatives, including closing care gaps and improving performance on HEDIS measures. 

Education/Experience Required:  Bachelor’s degree or equivalent required. 3+ years of experience in HEDIS record collection and risk adjustment (coding). 

Education/Experience Preferred:  RN, BSN 

Licensure/Certification Requirements:  LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, or CPC