Quality Specialist

EPIC Health System; Southfield (MI); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Competitive compensation and benefits package

Opportunities for professional growth

Excellent health insurance

401(k) investment opportunities

Job summary

A healthcare provider in Southfield, Michigan is seeking a Quality Specialist. The role requires strong data analysis skills and experience with HEDIS and Gaps in Care measures. Responsibilities include monitoring quality standards for patient care, collaborating with vendors, and providing training. The candidate should possess a Bachelor's Degree related to health and have two years of relevant experience. Competitive compensation and comprehensive benefits are offered.

Qualifications

• 2+ years of experience in the health industry.
• HEDIS/Gaps in Care experience is required.
• Knowledge of Patient Centered Medical Homes preferred.

Responsibilities

• Provides expertise in analysis of data for value-based programs.
• Collaborates with vendors for medical record collection.
• Monitors program status and reports on key performance indicators.

Skills

Data analysis

Team collaboration

Microsoft Office

Education

Bachelor’s Degree in related field

Job description

Quality Specialist Job Description

The ideal candidate for this role is compassionate, flexible, self‑motivated, detail oriented, and a constant learner. As a Quality Specialist, you will be the subject matter expert for HEDIS/Gaps in Care measures. You will ensure maintenance of programs for patients in accordance with prescribed quality standards; conduct data collection, reporting and monitoring for key performance measurement activities recognized by the NCQA.

Responsibilities

• Provides expertise in analysis of data related to supporting value‑based programs. Skills include accessing internal databases and tables as well as utilizing Excel skills.
• Participates in meetings with vendors for the medical record collection process and assists Manager with medical record vendor oversight.
• Participates in projects to ensure the strategic directives of the stakeholders are executed and time‑sensitive deadlines are met.
• Collaborate with providers and internal departments on rate investigation and validation activities, including maintaining all evidence, documentation, and changes.
• Monitor, evaluate and report on program status inclusive of scope, schedule, budget and alignment to program and strategic goals.
• Direct corrective action, as needed, to maintain the viability of value‑based reimbursement programs.
• Provide training and education to staff related to the data available, how to access it, and what metrics might be of interest.

Qualifications

• Bachelor’s Degree in related field and two (2) years’ experience in the health industry. An equivalent combination of education and experience may be substituted to meet this requirement.
• HEDIS/Gaps in Care experience.
• Knowledge of payers and their requirements for each measure.
• Knowledge of Patient Centered Medical Homes and Accountable Care Organizations.
• Microsoft Office skills.
• The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
• Tracking key performance indicators.

Benefits

• Competitive compensation and benefits package.
• Bi‑weekly competitive pay.
• Opportunities for professional and personal growth.
• Excellent health insurance through Blue Care Network with a VIP policy.
• Premium dental and vision coverage.
• Buy‑up option for short‑ and long‑term disability, and life & AD&D insurance.
• 401(k) investment opportunities.
• Generous holiday, vacation and personal time.
• Work/life balance.
• Employee recognition and assistance programs.