The Quality Reporting Specialist plays a critical role ensuring practice and ACO success in Medicare Advantage and commercial contracts, with a focus on HEDIS quality measures. Apply knowledge of HEDIS quality measures for addressing incentivized, contract measures across multiple Medicare Advantage and commercial health plans. Submit documentation to health plans and employ the optimal methods in each practice.
Conduct thorough reviews of medical records for accurate coding compliance.
Identify opportunities for documentation improvement to enhance code accuracy.
Educate healthcare providers on proper coding practices and HEDIS measures.
Jobgether uses an AI-powered matching process to ensure applications are reviewed quickly, objectively, and fairly against the role's core requirements. Their system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
The Director, MSSP Quality will lead cross-functional operational initiatives across Provider Networks and Product to ensure comprehensive data integrity and optimal performance in Quality reporting.
The Director will be responsible for managing and resolving field queries, preparing comprehensive reporting for executive and practice leadership, and formulating strategic initiatives for MSSP Quality programs across the organization.
The role requires strong leadership capabilities, analytical experience, and the ability to collaborate effectively with cross-functional teams while translating complex quality data into actionable insights that drive organizational excellence in MSSP Quality performance.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. Founded in 2014, they are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Provide ongoing support to providers to help them maintain high-quality care delivery and professional growth.
Monitor, track, and respond to clinical adverse events.
Work with Customer Support, Product, Provider Success, Clinical Quality, and Care Coordination teams to execute end-to-end clinical roadmaps and SOPs.
At SonderMind, we believe everyone deserves one personalized, connected, and effective mental health destination to take care of their mental health and well-being.
Be the primary point of contact for all providers.
Provide professional, accurate and timely responses to all provider inquiries.
Maintain a current knowledge of all contract requirements and objectives.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.
Execute data analysis of trends and strategic opportunities for quality improvement across Aledade’s value based care portfolio.
Track key performance indicators (KPIs) relating to risk, quality, and affordability for all health plan payer contracts.
Support ad-hoc reporting and data analysis requests for field teams specifically relating to MSSP.
Aledade empowers independent primary care practices to succeed in value-based care. Founded in 2014, they've become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Oversee the operations of the Imagine Pediatrics Onboarding, Credentialing, Licensing, and Enrollment Department. Develop and train on policies and procedures, workflows, and training documentation for the team. Manage Delegated Credentialing arrangements - implementation and audit – as well as ongoing Delegated partnerships with health plans.
Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs.
Play a critical role improving patient safety and quality. Support organization-wide workflow and technology improvements. Make a meaningful impact on patient outcomes within a supportive team.
The Clinical Operations, Quality Operations Specialist will play a key role in the operations of the Clinical Quality Program.
Creates and delivers education to the Coding Team, Clinical Documentation Nurses, Physicians, and other licensed providers to improve the quality of documentation.
Collaborates with the CMOs to ensure the integrity of the Health Record is established through best practices in Clinical Documentation and Coding.
Analyzes dashboard and audit data to derive conclusions and construct action plans.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace.
Conducts medium- to high-complexity investigations into alleged fraud, waste and abuse. Assists with the administration of Program Integrity activities. Supports the execution and oversight of moderate- to high-complexity privacy-related compliance activities.
Central California Alliance for Health is an award-winning regional Medi-Cal managed care plan providing health insurance to residents in multiple counties.
Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
Accountable for the management, performance, quality improvement and scalability of our HCP contractor base. Work cross-functionally with Product, Medical Directors, Data, Regulatory, Patient Experience, and Pharmacy teams. Combine people leadership, operational rigour, analytical ownership, and applied AI/automation in a regulated healthcare environment.
Founded in 2019, Felix is a patient-driven digital healthcare company that puts you in control of your health and wellbeing.
The SME – Health Systems Analyst serves as the clinical and operational authority for quality, patient safety, workflow validation, and clinical oversight. This role ensures safe, effective clinical operations during Pre-Deployment, Go-Live, and Stabilization. Provides leadership across ATE support and clinical backfill activities.
Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations and enhanced service delivery.
Develop deep understanding of the clinical data needs and data usability requirements across Devoted Health Plans and Devoted Medical.
Analyze clinical data availability across geographical areas to develop insights about data gaps, the reasons data is not available, and opportunities to obtain data.
Implement technical integrations with Health Information Exchanges (HIEs), Labs, Electronic Health Record (EHR) systems, and other sources of clinical data and ensure quality of data received.
Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Founded in 2017, they've grown fast and now serve members across the United States.
Completing moderation activities within specific SLAs.
Attending team and internal standardisation meetings.
Moderating centre marking and document outcomes in line with quality assurance guidelines.
NCFE is an organization with over 170 years of education experience, promoting and advancing learning to create a fairer, more inclusive society, making sure no learner is left behind.
Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.
Perform daily revenue integrity audits and charge reconciliation.
Monitor patient board and review census and discharges.
Collaborate with care providers to resolve missing documentation.
UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers and nearly 200 physician practice locations.
Acts as the clinical coding subject matter expert and lead coding resource across the organization.
Acts as a resource and provides education to providers on clinical coding standards.
Coordinates and leads the Alliance Coding Workgroup.
Central California Alliance for Health is a regional non-profit health plan that provides accessible, quality health care. The company has over 500 employees and fosters a respectful, diverse, professional, and fun culture where employees are empowered to do their best work.
The Provider Enrollment Specialist is responsible for timely and effectively enrolling practitioners in health plans. The Specialist will monitor progress, ensure timeliness of enrollment completion, and provide updates. The Specialist will maintain accurate provider profiles in IntelliCred and CAQH.
Pediatrix Medical Group is one of the nation’s leading providers of specialized health care for women, babies and children since 1979.