Reviews ambulatory care charts and applies HEDIS measures to identify and close quality gaps for Medicare Advantage and commercial health plans. Retrieves and submits documentation through payer portals and secure channels, coordinates EHR access, exports and reports results, and advises field teams on quality reporting strategies and practice performance barriers.
The Quality Reporting Specialist plays a critical role ensuring practice and ACO success in our Medicare Advantage and commercial contracts with a focus on HEDIS quality measures. The Specialist must be service-oriented, well-versed in HEDIS quality measures, and familiar with approaches for reviewing ambulatory care charts both electronic (EHRs) and paper to identify and submit documentation to address quality measure gap closure. This role requires strong attention to detail, great communication skills (both oral and written), and a passion for quality measure performance.
Primary Duties
Apply knowledge of HEDIS quality measures for addressing incentivized, contract measures across multiple Medicare Advantage and commercial health plans to ensure practice and ACO receive credit for services received by patient
Access practices in-person or remotely to retrieve documentation to address quality gaps and / or work closely with field team to assist guiding practices through gap closures
Submit documentation to health plans and employ optimal method in each practice (i.e., upload to payor portal, secure email, etc)
Coordinates Electronic Health Record (EHR) system access set-up & login management
Consult with market field team members on quality reporting strategy - providing relevant market updates and chart review feedback for assigned practices
Minimum Qualifications
1+ years experience in quality reporting in healthcare or health plan setting
Experience working within at least one (1) major Electronic Health Record system (athenaHealth, eCW, etc)
Comfortable exporting data, formatting and reporting out results (Excel or Google Sheets experience)
Able to work independently and prioritize deadlines
Track and communicate progress; escalate barriers to performance
Strong written and verbal communication skills
Strong attention to detail
Preferred knowledge, skills, and/or abilities
Bachelor’s degree is preferred or equivalent work experience
G-Suite Proficiency
Experience working with the Medicare Advantage STARS program and HEDIS measures
Physical Requirements
Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
Who We Are:
Aledade PBC, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade PBC, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options
And much more!
At Aledade PBC, we don’t just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
Privacy Policy: By applying for this job, you agree to Aledade's Applicant Privacy Policy available at https://www.aledade.com/privacy-policy-applicants
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