ACO Quality Specialist

memorialhermann; United States; On-site; USD 55,000 - 85,000; Full time

Job summary

Memorial Hermann in Houston seeks an ACO Quality Specialist to gather and manage data for quality improvement within the ACO population.

You will support population health by pairing payer data with outreach to meet performance metrics, address gaps in care, and analyze data using Excel and EMR systems.

The role requires a high school diploma or healthcare-related certification, 3 years of healthcare experience, and strong communication skills.

Qualifications

• Education: High School diploma or GED required.
• Licenses/Certifications: Degree or certification in the healthcare field required (e.g., Medical Assistant, LVN, Pharmacy Tech, SW, Health Coach, Coder).
• Three (3) years of healthcare related experience required with data support experience preferred.
• Experience working directly with patients, physicians and care team members required.
• Excellent computer skills including word processing and Excel; basic database knowledge.
• EMR software experience preferred.

Responsibilities

• Works as a member of the ACO/PHSO Quality team.
• Provides data and resources to practitioners and care team members to reach quality goals.
• Assist patients/physicians with addressing gaps in care for contracted payer populations.
• Outreach to patients/families and physicians per contractual metrics.
• Robust data management using payer files and Excel worksheets.
• Conducts claims research and audits medical records to show performance vs metrics.
• Participates in special projects and takes ownership of initiatives to achieve outcomes.
• Supports safety, quality and compliance with MH policies and standards.

Skills

Healthcare data analysis

Patient interaction

Excel proficiency

EMR software experience

Oral and written communication

Multitasking

Education

High School diploma or GED

Healthcare-related degree or certification (e.g., Medical Assistant, LVN, Pharmacy Tech, SW, Health Coach, Coder)

Tools

Electronic Medical Records (EMR) software

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The ACO Quality Specialist is responsible for ongoing data collection and management of quality improvement initiatives specific to the ACO patient population. The position includes ongoing quality improvement activities to ensure the organization's quality program meets the requirements for successful completion of all contracted payer performance metrics. The role pairs payer data with specific outreach initiatives to meet the performance goals of the organization.

Minimum Qualifications

• Education: High School diploma or GED required
• Licenses/Certifications: Degree or certification in the healthcare required; Acceptable degrees and certifications include, but are not limited to, Medical Assistant, LVN, Pharmacy Tech, Bachelor of Social Work, Health Coach, Coder, etc.

Experience / Knowledge / Skills:

• Three (3) years of healthcare related experience required with data support experience preferred
• Experience working directly with patients, physicians and other interdisciplinary care team members required
• Excellent computer skills, including proficiency in word processing and Excel software with basic knowledge of database applications
• Electronic medical records software experience preferred
• Effective oral and written communication skills
• Demonstrate superior written and verbal communication skills, as well as ability to manage multiple tasks and priorities simultaneously

Principal Accountabilities

• Serves as a member of the ACO/PHSO Quality team.
• Provides data and resources to practitioners and care team members for management of population groups and individual patients to reach quality goals and maximize quality outcomes.
• Assist patients/physicians with addressing gaps in care for contracted payer populations
• Provides outreach to patients/families and physicians in accordance with goals set within contractual and clinical outcome metrics.
• Robust data management using payer files and Excel worksheets to track outcomes.
• Conduct claims research and audit medical records to demonstrate performance against payer contract performance metrics.
• Participation in special projects such as member outreach initiatives.
• Takes ownership of specific projects and/or endeavors to reach desired outcomes, on both a macro and micro level, as needed. Requires problem-solving skills and strong interpersonal skills.
• Participates in performance improvement activities.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

Other duties as assigned.