Job Description

Job Description

Job Description

Description:

We are seeking a dedicated Quality Specialist to support Gather Health, an at-risk primary care group for seniors. The ideal candidate will have a strong background in HEDIS and STARs quality metrics and quality program support. This individual will play a critical role in driving improvements in STARs ratings through workflow, reporting, and collaboration with clinical teams and patients to drive exceptional patient outcomes. This position is primarily a remote role but may require infrequent travel to clinic sites for in-person work.

· Works collaboratively with the Quality Manager to perform chart audits and data collection to ensure gaps in care are addressed and closed per HEDIS and payer guidelines.

· Learns and utilizes the companies’ resources appropriately and as needed for chart chase purposes to close open gaps: (Athena EMR, Navina AI tool, outside portals)

· Contacts patients as needed for collecting or providing information related to preventive tests completed or scheduled.

· Request reports from outside providers or facilities by phone or through fax and track as needed.

· Submit documentation to payers through their preferred method for gap closure.

· Identifies opportunities for improvement and shares timely feedback.

· Utilizes tracking tools for daily productivity reporting.

· Attends meetings as needed for quality education or discussions (provider or staff education)

· Cross train with Referral Coordination department to support referrals for HEDIS related measures. (sending orders, scheduling the patients and following through for completion of the tests/screening scheduled)

· Other support as needed related to special projects pertaining to HEDIS gap closure.

· Maintain up-to-date knowledge of regulatory HEDIS/STARs standards and guidelines and serve as a subject matter expert on HEDIS and STARs guidelines, providing training and support to staff

· Coordinate with clinical staff to inform them of missing screenings and HEDIS/STARs gaps

Experience required:

· Demonstrated ability and knowledge in managing diverse clinical data collected from patient records. (knowledge in HIPAA rules)

· Familiar with working in various EMR’s (Athena a plus)

· Knowledge and experience in HEDIS/STARS measures (2 years’ experience preferred)

· Ability to manage multiple projects simultaneously and meet deadlines

· Proficiency in data management tools such as Excel

· Previous experience in primary care practice a plus

· Licensed Vocational Nurse or Medical Assistant strongly preferred

Gather Health is committed to equal employment opportunity. At Gather, we embrace diversity and are dedicated to creating an inclusive workplace for all candidates and team members. Employment decisions are made without consideration of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, marital status, age, disability, political beliefs, military experience, genetic information, or any other characteristic protected under federal, state, or local legislation.

Gather Health uses E-Verify to confirm the work authorization of newly hired employees.

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