Specialist, Quality - Remote
ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.
Job Summary:
ArchWell Health’s Quality Specialist will be an integral part of the central services team. The Quality Specialist is responsible for the monitoring and pursuit of CMS STARS HEDIS measures, conducting central patient outreach calls, and partnering with market leaders for strategy and data sharing. This role will interconnect with operations, patient care teams and ArchWell Health members. This role will work across many payors over multiple markets and states in an outpatient senior-focused primary care setting.
Duties/Responsibilities:
Conduct enterprise and local strategies and initiatives for closing STARS gaps
Medical record review for HEDIS® and HEDIS®-like measures (Focus On Care)
Over-read of medical records
Perform central patient outreach calls
Meet regularly with Quality Leaders and Market Leaders to discuss any roadblocks, month to month progress and strategize center focused initiatives
Build relationships and collaborate with the Pharmacy team and market leadership to ensure maximizing efforts when outreaching to patient for multiple STARS gaps
Submit supplemental data to Health Plans as needed on a regular cadence
Additional responsibilities and duties as assigned
Required Skills/Abilities:
Working knowledge of ICD-10, CPT, and HCPCS codes preferred
Proficient with Microsoft Office Suite products including Word, Excel, Power Point, and Outlook, and Teams
Willingness and ability to travel for on-site clinical education on occasion
Demonstrated team building skills
Excellent presentation, verbal, and written communication skills
Ability to exercise use of independent judgement
Sensitivity to the diverse needs of culturally diverse staff, patients, and communities
Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately
Embodies and serves as a role model of ArchWell Health’s Values:
Be compassionate
Strive for excellence
Earn trust
Show respect
Stay resilient
Always do the right thing
Education and Experience:
Associate degree or equivalent preferred
Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) credentials preferred
Experience with the CMS STARS program (HEDIS) preferred
Experience with Electronic Medical Records, eClnicalWorks preferred
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.