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Provider Engagement Quality Specialist - ACO/PO
Farmington Hills, MI
Job Description
Why This Role is Important to Us:
What You'll Be Doing:
What We're Looking For:
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
The Specialist, Quality -- Provider Engagement -- ACO/PO monitors Quality Measures within Accountable Care Organization physicians' offices for Group Practice Reporting Options (GPRO). Conducts onsite reviews and audits for Medicare compliance. This position partners with providers to support in office improvement efforts aimed at increasing the rate of preventive and annual screens delivered to CCA members to meet established target performance to achieve CMS quality bonus status for the Accountable Care Organization.
Supervision Exercised: None
What You'll Be Doing:
- Be the plan conduit to provider practices in Michigan; develop provide educational materials and trainings to increase effectiveness to close clinical gaps in their patient care with CCA membership; use data and reporting to deliver feedback, identify areas of need and communicate to practices opportunities for improvement.
- Contact and work with doctor's office on notification, scheduling, and logistics for completing the review.
- Conduct on-site review and document all quality information from the files reviewed.
- Review reports for audit scope. Research and analyze reports to narrow and define scope for on-site review and review period.
- Work with physician's office staff in obtaining information for completion of reviews and audits.
- Prepare review audit findings and reports identifying, areas of non-compliance and risk areas for non-compliance.
- Manage risk areas for non-compliance with office contacts and provide education, create roadmap to improving compliance with physician, or office staff to reduce risk identified.
- Build relationships with physician's office staff for future activity. Escalate office or relationship issues to CCA ACO Michigan leadership.
- Work with other CCA ACO employees and leadership to obtain, share and suggest information for advancing the mission of the organization.
- Conduct EMR/record searches for audit measures with multiple year look back periods to improve chart capture rates (for instance: colorectal cancer screenings and mammograms)
- Develop strong professional relationships with all providers and their staff while functioning as a liaison to the provider community.
- Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and appreciation events.
- Other duties as assigned.
Working Conditions:
Standard office conditions; more than half of the time, the position will be working in designated primary care practices to support improvement activities.
- Valid Driver's license and reliable insured automobile required
- Must be able to travel within an assigned territory daily
What We're Looking For:
Education Required:
- High School Degree
Education Desired:
- Associate degree
Experience Required:
- Experience with medical terminology acquired through two years' work experience or education.
- Previous quality experience
Experience Desired:
- 1-2 years of HEDIS quality experience (as evident by HEDIS audits)
Knowledge, Skills & Abilities Required:
- Attention to detail, analytical skills, ability to work independently, time management.
- Excellent verbal, written and presentation skills.
- Outstanding Customer Service Skills.
- Intermediate Microsoft Office competency, including Outlook, Word, Excel & Power Point.
- Ability to multi-task.
- Ability to interact well with individuals on all levels and maintain a professional image and attitude
Language(s) Required:
- English
Other Required:
- Valid Driver's license and reliable insured automobile required
- Must be able to travel within an assigned territory daily.
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
High School or Equivalent
Required Experience
2+ years
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