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HEDIS / Quality Auditor

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POST DATE 8/9/2016
END DATE 12/19/2016

Integrated Resources Inc Trenton, NJ

Company
Integrated Resources Inc
Job Classification
Full Time
Company Ref #
28655464
Location
Trenton, NJ
Job Type
Regular
AJE Ref #
575826622

JOB DESCRIPTION

POSITION TITLE: HEDIS/ QUALITY AUDITOR

LOCATION: WEST TRENTON, NJ

DURATION: 6 MONTHS

JOB SUMMARY:

This position is responsible for managing HEDIS and Stars performance by working with low performing providers to identify areas of opportunity. The Liaison will be the main Qualitycontact for providers, they will provide guidance and resources in order for the provider to achieve target Quality Performance metrics, as established by the National Committee for Quality Assurance.

RESPONSIBILITIES:

* Responsible for being the main liaison for the Quality Management department and all assigned provider groups to improve HEDIS and Stars Quality Performance
* Monitor and analyze provider Quality Performance Reports. Identify areas of improvement, provide assistance with root cause analysis, assists with developing solutions, and develop a work plan to monitor progress.
* Conduct on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation.
* Collaborate with Value Based Programs and Provider Contracting and Services to manage provider quality performance.
* During HEDIS season, assists with the retrieval of charts, chart abstraction, and chart review entries. Must adhere to the HEDIS guidelines for chart review abstractions and standards.
* Provide HEDIS provider guidelines that highlight appropriate HEDIS codes for claims submission.
* Assists in the development of member and provider outreach, engagement, and education materials to improve Quality Performance.
* Completes other assigned functions, including special projects, as requested by management.

QUALIFICATIONS:

EDUCATION/EXPERIENCE:

* Requires 4 YearDegree or 4 years of relevant years of work experience. LPN, RN, LMSW or LCSW preferred.
* Requires a minimum of three (3) years' experience in a healthcare setting: health plan, hospital, physician practice, or managed care organization
* Prefers experience in continuous quality improvement and/or quality management.

KNOWLEDGE:

* Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Microsoft Outlook.
* Should be knowledgeable in the use of intranet and internet applications.
* Prefers knowledge of Population Health Management and Preventative Management Programs
* Prefers Project Management skills.

SKILLS AND ABILITIES:

* Requires excellent verbal and written communication skills.
* Analytical & Problem Solving
* Continuous Improvement
* Information & Knowledge Sharing
* Process Management
* Interpersonal & Client Relationship
* Presentation Skills