Clinical Quality Specialist I

Job Description Summary

‎

The Clinical Quality Specialist I supports the annual HEDIS data collection and reporting process by performing chart review and retrieval, as well as documentation validation. This role ensures patients receive multiple opportunities to meet HEDIS specifications, assist with outreach to patients and other medical facilities for missing information. Works under close supervision and follows established workflows to help the organization meet quality performance goals. Minimum of three years’ experience in a medical clerical role.

‎

How will you make an impact & Requirements

‎

The Clinical Quality Specialist I supports the annual HEDIS data collection and reporting process by performing chart review and retrieval, as well as documentation validation. This role ensures patients receive multiple opportunities to meet HEDIS specifications, assist with outreach to patients and other medical facilities for missing information. Works under close supervision and follows established workflows to help the organization meet quality performance goals. Minimum of three years’ experience in a medical clerical role.

Key Focus Areas

• Proficiency within EMR systems and record keeping portals.
• Conduct patient outreach to order and schedule preventative services and tests.
• Aid in sustaining continuous reconciliation of patient data with payors and internal systems.
• Perform data entry and maintain tracking spreadsheets.
• Retrieve and review external medical records for gap closure.
• Validate documentation against HEDIS requirements.
• Escalate issues to team lead as needed.

Originally posted on Himalayas