Job Title: Quality Improvement Specialist
Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com.
RESPONSIBILITIES:
Position Purpose:
- Support the development and maintenance of quality improvement related projects and reporting
- Respond to quality improvement inquiries
- Monitor the production of quality results reporting; analyze, track and trend the reporting results and report them to management
- Formulate and prepare ad-hoc and additional reporting requirements
- Recommend, develop, and implement quality improvement plans with management
- Train providers and staff in methodologies and tools of continuous quality improvement
- Prepare for and participate in meetings with State agencies, providers, and stakeholders
- Perform audits on to meet state and internal requirements
Business Group & Key Projects:
- Quality Improvement team members focused on the HEDIS Hybrid project. This role will be focused on medical record retrieval, vendor portal request management, provider outreach and document processing and management.
- Goal to retrieve medical records to improve HEDIS rates across all lines of business in the Illinois health plan (Medicare, MMP/Duals, Medicaid, Youthcare and Marketplace)
Typical Day in the Role:
- Conduct outreach, track retrieval progress, research contact information, process incoming medical records. Meet individual goals, and support team and organization goals.
- This position will be primarily telephonic outreach to provider offices, among other administrative tasks like PDF processing and navigating portals for daily tasks.
- Collaborate with team members to support efficient medical record retrieval
QUALIFICATIONS:
Top 3 Must-Have Hard Skills:
- Experience in Quality Improvement and Provider telephonic outreach initiatives for Medical record retrieval
- HEDIS measure knowledge
- Experience with medical record/document management (processing, separating and re-naming PDFs)
Must Haves:
- Medical record retrieval experience via provider outreach
- HEDIS measure knowledge and experience
Nice to Haves:
- Experience with Datavant/CIOX vendor portal (note CIOX changed names last year, so either name recognition suffices as vendor portal is the same)
- Experience with Datafied vendor portal (similar name as above, but indeed separate)
- EMR Datamining for HEDIS services
- Experience working on HEDIS Hybrid project
Disqualifiers:
- Significant time off needs between January and May
Performance indicators:
- Medical record retrieval rate (Weekly targets)
- Pends (or tasks) age
- Production with medical record processing
Education/Experience:
- Bachelor’s degree in related field or equivalent experience
- Preferred: 3+ years of related experience
License/Certification:
- Valid driver’s license
- Required – Certified Professional in Health Care Quality (CPHQ)
- Heavy chart monitoring and auditing of medical records
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/