Specialist, Quality

What You’ll Do 

Position Summary

The Specialist, Quality will work closely with our clinic staff to identify gaps in care, capture HEDIS documentation, perform chart audits, track patient engagement in care gap, and notify clinics of time sensitive care caps. They will also work with the Director of Quality to report low clinic engagement, opportunities for staff education, and reporting inaccuracies. Essential responsibilities consist of, but are not limited of the following:

Responsibilities

• Identify and notify clinical staff of next steps needed to address open quality gaps.
• Submit documentation to payer portal to close quality gaps.
• Audit supplemental data to ensure results are compliant for identified measures.
• Educate staff and providers on HEDIS technical specifications.
• Resolve clinical staff Quality inquiries.
• Join daily huddles as needed to inform clinical staff of patients with outstanding time sensitive measures. 
• Collaborate with other departments on quality specific projects to help reach quality goals.
• Actively participate as a team player to promote positive health outcomes for our patients. 
• Able to work Monday-Friday from 8-5PM MST and be in the DFW area.
• This is a 1099- Contract position.
• Be willing to take on additional task to support the overall success of the organization.

What You’ll Bring

Education Requirements 

• Bachelor's degree in healthcare administration or public health required 

Certifications Requirements 

One of the following certifications, accompanied by 2+ years of experience in value-based care setting (primary care or Medicare Advantage Plans preferred): 

• Certified Medical Assistant  
• Certified Pharmacy Technician  
• Certified Nursing Assistant   
• NCQA certification   

OR 

 Experience Requirements 

• 4+ years of experience in value-based care setting (primary care or Medicare Advantage Plans preferred)  
• 2+ years of HEDIS or Risk Adjustment experience in supplemental data and chart reviews  
• Knowledge of CMS STARS program  
• Must have a basic understanding of billing and claims coding  
• Experience reviewing Electronic Medical Records  
• Intermediate level experience in working in Microsoft Excel, Word, and PowerPoint  
• Experience navigating payer portals.  
• At least 1 year of experience utilizing medical terminology.   

Skill Requirements

• Ability to work independently  
• Strong problem-solving skills with the ability to identify solutions independently and know when to appropriately escalate complex issues 
• Ability to multi-task  
• Ability to work in fast paced environments with changing priorities.  
• Bilingual (English/Spanish) preferred

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.