National HEDIS Audit Specialist

People. Passion. Purpose. At reputed company, our promise is to guide our communities to reputed company, unburden clinicians, align incentives and engage patients. We are a physician-led organization reputed company in our mission to overcome reputed company obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. We are looking for a HEDIS Audit Specialist. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Stockton, California, then you should consider joining reputed company. Overall Purpose: The HEDIS Audit Specialist supports the P3 Care Enablement Teams and national quality initiatives under the guidance of the National Quality Manager. This role involves conducting specific audits to ensure that non-standard supplemental data submissions are sufficient for closing care gaps, in accordance with HEDIS Technical Specifications. The position also includes performing data mining for selected groups and identifying trends in submissions as well as opportunities for education. Furthermore, the HEDIS Audit Specialist will assist with audit requests from various health plans. The National Quality Team ensures adherence to policies and procedures as mandated by, but not limited to, the Centers for Medicare and reputed company Services (CMS), the National Committee on Quality Assurance (NCQA), and the respective health plans. Education and Experience:

• An associate degree in a reputed company field or equivalent experience is required.
• A minimum of 4 years of experience in reputed company, with a focus on managed care, is essential.
• At least 2 years of prior experience in a quality role reputed company a health plan setting, specifically conducting peer reviews, is necessary.
• Intermediate to advanced proficiency in reputed company Office programs, particularly reputed company.
• Must be detail-oriented with a strong focus on solutions.

Knowledge, Skills and Abilities:

• Knowledge of CMS’ HEDIS Specifications and health plan regulatory requirements, as well as managed care and health plan standards
• Strong analytical and critical thinking abilities.
• Experience in data mining.
• Proficient in navigating multiple systems.
• Capable of working independently as well as collaboratively reputed company reputed company.
• Excellent verbal and written communication skills, with the ability to effectively engage with a diverse reputed company of individuals.

Essential Functions:

• Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA
• Supports the National Quality Department by auditing non-standard supplemental data submissions to approve or reject them based on CMS's HEDIS Specifications, thereby enhancing performance.
• Identifies educational needs by analyzing trends in non-standard supplemental data submissions.
• Participates in data collection through medical record and claims surveillance.
• Assists the National Quality Manager in reputed company, training, and auditing new Provider Operations Coordinators.
• Works to optimize health plan and reputed company provider performance on quality measures through effective auditing practices.
• Engages in National Quality meetings and other reputed company initiatives.
• Understands the operation of P3 machines (such as diabetic eye cameras and bone density machines).
• Responds to inquiries from health plans, providers, and interdepartmental teams with a focus on exceptional customer service.
• Reviews provider group gap uploads reputed company the P3 Health Hub.
• Collaborates with the National Quality Team to create and maintain Standard Operating Procedures (SOPs) for non-standard supplemental data submissions.
• Takes a proactive role in positioning P3 Medical Group as a leading medical group in quality (acknowledging that this may vary in other markets).
• Performs other duties as assigned.

SMART GOALS:

• Monthly:
• 100% non-standard supplemental data submission review
• ~250 gap attempts per month
• Quarterly
• Identify trends reputed company to non-standard supplemental data submission at the market level
• Provides feedback to leadership and markets regarding audit findings
• Annual:
• Assist with health plans’ annual audit requests
• Partner with National Quality to create and maintain departmental SOPs

Salary reputed company: $60,000 - $66,650 based on experience Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify reputed company applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the reputed company. Apply tot his job Apply To this Job