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Quality Specialist FT, Day
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Prisma Health
Greenville, SC (In Person)
Full-Time
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Job Description
Inspire health. Serve with compassion. Be the difference. Job Summary Job Profile Summary Focuses on one or more areas of clinical practice performance improvement and practice transformation. Under the guidance of senior staff, coordinates and supports clinical initiatives that promote high quality care across the network using best practice models of care. Supports the relationship for the performance reporting and quality improvement program between the accountable care organization (ACO) and/or clinically integrated network (CIN) and the practices/providers in the network. Is the primary resource and liaison between the network's performance management and operations team and the practice and providers. Collaborates with the practices and providers in order to drive improvement in operational performance and clinical outcome measurements. Supports CCI client activities in (i) applying for, managing or maintaining clinical quality programs such as Patient Centered Medical Home (PCMH) or other similar primary care or specialist quality programs, including recognition updates, upgrades and renewals, (ii) directing activities for integrating new practices into the quality program(s) and associated processes and (iii) reporting quality performance to CMS for the Medicare Shared Savings Program (MSSP) and the Merit Based Incentive Payment System (MIPS) in addition to other reporting projects as applicable to commercial and government payors. Serves as an educational resource for the practices and providers and ensures they are well-educated about programs and supports them in their understanding of practice transformation, quality reporting and related initiatives. Works with the performance management and information technology teams to compile data and improve individual physician performance as necessary. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference. Supports large network providers (multi-provider sites, hospital/facility-based practices) in the review and analysis of quality improvement programs related to provider quality reporting. Visits providers in their offices (in the field) and provides associated customer service/support for the ACO/CINs' quality programs. Facilitates, develops and coordinates best practice and quality improvement activities to advance the transformation of care across the ACO and other applicable providers in the CCI client base. Develops knowledge in one or more areas that may include: CMS quality programs (MSSP, PQRS, MIPS), NCQA programs (PCMH certification and recognition standards), and other best practice care models, policies, processes and application requirements. May initiate, analyze, audit, or submit CMS quality reporting and/or NCQA applications submissions, and audits for CCI clients under the supervision of Senior Quality Specialists. May educate and instruct appropriate leaders and practice staff in their responsibilities related to quality programs under the supervision of Senior Quality Specialists. Escalates issues, questions to Senior Quality Specialists. Provides outstanding customer service to CCI clients and the providers in their networks/delivery systems. Supports the development of and delivers organized training (small/large groups) and webinars (live and recorded) related to the ACO/CIN quality programs. Provides feedback to the data operations, data quality, and performance management teams in response to what is learned in the field. Provides feedback to the data operations, data quality and performance management team regarding new product development, design, and implementation. Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - Bachelor's degree in Health Sciences, Social Work, Public Health, Biology, Chemistry or related field of study. Experience - No experience required. One (1) year healthcare service experience including nursing, office/practice management, medical assistant, medical/claims coding, EHR/EMR data input or data analytics in another field/industry preferred. In Lieu Of In lieu of education and experience noted above, an equivalent combination of work/academic experience may be considered (i.e., four years of related work experience or Associate degree in a healthcare or technical field and two (2) years of experience in a healthcare field or a Masters degree in related field of study) Required Certifications, Registrations, Licenses NA Knowledge, Skills and Abilities Ability to remains current and knowledgeable about physician/provider/practice quality reporting for accountable care organizations and clinically integrated networks Knowledge of healthcare quality and process improvement experience preferred Knowledge of databases, statistics and mapping software/tools preferred Work Shift Day (United States of America) Location Prisma Health Corporate Office Facility 7002 Value-Based Care and Network Services Department 70029261 Ambulatory Quality and Reliability Share your talent with us!