Bilingual Quality Specialist – HEDIS & Care Gaps (AZ)

Suvida Healthcare LLC; Tucson (AZ); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Competitive Pay

Mental Health & Life Coaching

Holiday Time Off

Paid Community Service Day

Parental Leave

Generous PTO

401k Match

Job summary

Suvida Healthcare LLC in Arizona is seeking a Quality Specialist to join our primary care focused team serving Medicare-eligible Hispanic seniors. You will identify care gaps, audit data, and collaborate with clinic staff and the Director of Quality to improve HEDIS performance and reporting accuracy.

The ideal candidate has 4+ years in value-based care, HEDIS or Risk Adjustment experience, and knowledge of CMS STARS, billing concepts, and payer portals.

Qualifications

• Bachelor's degree in healthcare administration or public health required.
• 2+ years of experience in value-based care setting.
• 2+ years of HEDIS or Risk Adjustment experience in supplemental data and chart reviews.
• Experience reviewing Electronic Medical Records.
• Intermediate level experience in Microsoft Excel, Word, and PowerPoint.
• Experience navigating payer portals.
• At least 1 year of experience utilizing medical terminology.
• Knowledge of CMS STARS program.
• Must have a basic understanding of billing and claims coding.

Responsibilities

• Identify and notify clinical staff of next steps needed to address 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 and be in the Arizona area.
• Be willing to take on additional task to support the overall success of the organization.
• 10% travel within Arizona

Skills

Independent work

Problem solving

Multi-tasking

Agile to fast-paced

Education

Bachelor's degree in healthcare administration or public health

Tools

Excel

Word

PowerPoint

Job description

Suvida Healthcare LLC in Arizona is seeking a Quality Specialist to join our primary care focused team serving Medicare-eligible Hispanic seniors. You will identify care gaps, audit data, and collaborate with clinic staff and the Director of Quality to improve HEDIS performance and reporting accuracy.

The ideal candidate has 4+ years in value-based care, HEDIS or Risk Adjustment experience, and knowledge of CMS STARS, billing concepts, and payer portals.