This position, which reports directly to the Quality Improvement Manager, is responsible for converting data into information from the operating system and other sources of input on a continuous basis for purposes of participation in strategic planning and for analysis and improvement in our clinical operations. Actively collaborates with other department managers, team members and leaders to facilitate full analysis of impact of information on the strategic, business and quality plans. Information will include monthly, quarterly, annual and ad hoc reporting, analysis and forecasts; bench-marking and comparative interpretation of utilization, financial and clinical performance of institutional and individual providers and provider regions. Responsible for creating reports that will be used as management decision support tools for forecasting performance of Associates and Providers. This position is responsible for providing vehicles for reducing time requirements of department heads for creating of reports to the Department of Defense and other oversight entities. Maintenance of quality information system files will be overseen by this position. This position actively collaborates with the Sr. Financial Planning Analyst to synergy of effort.
- Develop and maintain physician profiling system utilizing information obtained from monthly managed care reports
- Provide comparison physician data to Leadership, Management, Medical Staff Leadership and network physicians on a quarterly basis
- Develop and maintain statistical data of network physician practice patterns
- Coordinate quarterly information related to physician’s quality of care provided to members
- Act as resource person for staff and other department within CHRISTUS Health to ensure effective and efficient workflow
- Participate in development of system enhancements to increase the effectiveness of the physician profiling system
- Collaborate with Management and Leadership to evaluate impact of financial plans on clinical outcomes. Collaborates with all Associates and other customers, internal and external as required to perform responsibilities of job.
- Participate in the Quality Improvement program integrating QI issues into profiling system
- Present analysis to Medical Staff Leadership at Quarterly Meetings
- Prepare analysis for Department of Defense, CHRISTUS Board Quality Committee and National USFHP Alliance quarterly
- Prepares analysis for quarterly reports and annual evaluations
- Maintain continuing education hours adequate for certification
- Actively research literature, electronic media, latest healthcare statistics, standards and/or comparison data.
- Surveys healthcare environment and keeps Quality Management team apprised of relevant changes in healthcare standards, environment, regulations, legislation
- Identify and apply best statistical methodologies for rendering information to target audiences
- Ability to meet deadlines in high pressure environment
- Demonstrates effective interpersonal skills in intense situations
- Active participant in health plan accreditation. Maintains current knowledge with regards to URAC standards and ensures compliance within scope of responsibility.
- Tracks laws and regulations applicable to the Quality Improvement and ensures compliance with those regulations.
- Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
- Perform other related duties as requested by the Medical Director and/or Manager
- Adhere to departmental as well as corporate policies and procedures
- Project and team management
- Bachelor Science or Business Degree. MBA, MHA, or MSN preferred
- Proficient in a variety information systems and software applications (Word Processing, Spreadsheet, Database, Project Management and Statistical products)
- In-depth knowledge of standards regulating health plan compliance
- In-depth knowledge of reporting guidelines and standards regulating health plan compliance
- Excellent verbal communication skills
- Thorough understanding of managed healthcare billing/coding systems
- In-depth knowledge of managed care concepts
- Exceptional documentation skills
- In-depth knowledge of principles of Performance improvement/Quality Management
- Self-directed analytical abilities
- Research oriented
- Aptitude for application software
- Follow the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
- Bachelor of Sciences or Bachelor of Arts in Accounting, Finance or Healthcare
- MBA or MHA preferred
- Prior Project Management Experience
- 3-5 years experience in clinical informatics, or financial reporting and analysis with special emphasis on experience in managed care.
- 3-5 years experience in profiling of physicians. MBA or MHA plus relevant work experience may be considered in lieu of this requirement.
- Project Management Certification Preferred