TheQuality HEDIS Program Coordinator will act as a liaison between the ACO and the participating providers and other healthcare professionals regarding the CMS GPRO Quality Metrics Audit for GulfCoast Accountable Care Network. This position will be responsible for electronic and/or paper medical records, will adhere to scheduled appointments with participating provider offices to conduct audits, and will input records in compliance with all HIPAA regulations. Responsible for the ACO program HEDIS management by coordinating the CMS on GPRO submission; identification, collection and abstraction of medical records and other data in collaboration with ACO participant's HEDIS staff.
- Responsible for the coordination and collection of GPRO quality data preparation by conducting medical record review which includes ongoing review of records submitted by ACO participants and the annual GPRO medical record review.
- Design the process to continually communicate ongoing feedback to ACO participants on critical HEDIS reporting.
- Identifies gaps based on data collected from ACO participants.
- Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors.
- Assists the ACO participant's QI staff with physician and member interventions as needed.
- Responsible for leading annual reporting and tracking of GPRO submission for ACO reporting
- Acts as the lead project manager for annual CAHPS survey
- Collaborate with ACO participants staff on programs to support CAHPS survey results
- Maintains system for tracking and reporting progress HEDIS and CAHPS
- Proficient with PC-based systems and the ability to learn new information systems and software programs
- Ability to work with large files and data sets
- Strong communication and teaming/interpersonal skills; strong leadership capabilities
- Ability to initiate and maintain cross-team relationships
- State Licensed Vocational Nurse (LPN) or Registered Health Information Technician (RHIT), or Certified Medical Record Technician with training in coding, or other nationally recognized coding certification.
- 2-4 years coding and medical record abstraction experience.
- 2-4 years managed care experience.
- Basic knowledge of HEDIS and NCQA.