It is the direct responsibility of the quality coordinator to ensure the market’s success of patient focused care models to reach the highest achievement possible. It is their job to meet the individual metrics of each program we participate in. QC is responsible for taking action on all quality attribution reports from scheduling to closing gaps in care and submitting data to the various payers. The QC will assist providers and staff with development of the skills necessary to adapt CHS best practices related to quality care workflows. This role will interact closely with the Regional Quality Director and CHS PPS Department. The QC is responsible for ensuring the accountability of the local team to achieve measurable gains within the programs, as measured by internal and external metrics.
Scope: Physician practice quality coordinator responsibilities and functions under the administrative supervision of the Regional Quality Director
Essential Duties and Responsibilities:
- Deliver best practices for operating policies, procedures and principles, set forth by CHS leadership and escalate as needed to hold market personnel accountable.
- Hardwire CHS “Every patient/ every time” quality best practice workflows into behavior adoption
- Support practices as local quality subject matter expert until needs are resolved
- Respond to Leadership requests/ action plans, timely, as needed
- Interface w/ MCO payers, as needed
- Ensure through local resources that TCM eligible patients are contacted within 2 business days and scheduled within 7 days
- Ensure open schedules are maximized with preventative and chronic management appointments after same day availability need is met (i.e. fill schedules for patients with open gaps in care or CCM)
- Ensure appointments are being optimized for ACV/GIC closure (Utilization of Chart Prep prior to OV)
- Maintain a minimum of 80% ACV Scheduling/ Completion for market (target changes annually)
- Monitor all quality improvement efforts, report status to key stakeholders and intervene to address concerns
- Round with providers/key stakeholders weekly to support CHS best practices/ efficient workflows
- Provide ongoing training , support, and coordination of quality care to the practices
- Complete HQPAF Worklist (Schedule Appt./Submit Documentation)
- Ensure timely submission of nonstandard or payer specific PAFs
- Ensure the capturing of HCC/RAF/Suspect Conditions to the highest level of specificity
- Audit charts for workflow opportunities by user
- Take action on prescription reports/worklist (Real-time compliance and Pt measures)
- Attend Bi-weekly AMR Build Coordinator Call
- Huddle w/ PM and key stakeholders on KPI weekly/daily
- Complete ED Frequent flyer outreach and ensure frequent care touchpoints are established with patient
- Complete medical record requests to outside offices to close gaps in care
- Complete best practice workflows for each MCO/ACO incentive program we participate in
- At the guidance of the RQD, present KPI/action plans/assign owners at practice meetings
- Reviews rosters for data integrity, escalate to RQD/MC
- Serve on local quality committee/ document and report improvement activities, if applicable
- Working with AMR FTE, ensure AMR is optimized for local tablespace for performance and pop health mgmt.
- Monitor chart prep, QM tools for utilization, provide feedback, and hold stakeholders accountable
- Share scorecards (translate performance) with stakeholders & providers
- Actively participate in monthly quality calls with RQD
- Complete medical record requests from payers related to quality audit reviews
- Utilize Physician leadership to address resistant behaviors and gain buy-in
- Participate in competencies/skills labs as needed
- Provide refresher on HCC/RAF/Suspect Conditions/CPT II and other coding related education to providers and staff, as needed
- Attend/participate in regional quality meetings, as scheduled
- At the request of RQD, Organize/Lead Wellness Days/Events for local market
- GPRO Audit, completed timely
- Responsible for all other duties as assigned by leadership
Required Education: High School Diploma or GED Equivalent or Associate's Degree
Preferred Experience: One (1) Year Experience in healthcare field; preferably physician
office/clinic setting, hospital owned
Project & Physician-Provider Practice Relationship Experience
Basic understanding of HEDIS quality measures.
Basic understanding of health care administration, clinic philosophy, and policies and operating procedures.
Basic understanding of governmental regulations and reimbursement requirements.
Basic knowledge of legal issues relating to physician-owned practices and hospital-employed physicians.
Basic knowledge of managed care industry, understanding of EMR quality management data and /or physician practice management applications. This should be combined with a succinct understanding of physician practice operations including of how charge capture and clinical documentation affects quality improvement.
Preferred License/Registration/Certification: Clinical certification of some type (CMA, LPN, RN) preferred, but not required.
Computer Skills Required:
Google Suite including Gmail, GDrive, GSheets, GCalendar, etc.
Microsoft Office Suite including Word, Excel, Power Point, and Visio
Kronos, Athena, Cerner and the ability to learn multiple new systems being used in the organization to perform daily operational activities