Manager HEDIS Quality Auditing-Southwestern Health Resources CIN at Southwestern Health Resources CIN in Pittston, Pennsylvania

Job Description:

Please note: Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is an affiliated company of Texas Health and UT Southwestern. If hired for this position, you will become a SWHR CIN employee rather than a Texas Health or UT Southwestern employee.

Southwestern Health Resources Clinically Integrated Network (SWHR CIN), is hiring for a Manager Quality Auditing.

This position will be responsible for oversight of daily tasks, team and Network education and operations of Quality Auditors which includes: Daily monitoring of daily audit goals, development of training material, processes and education. This role will also establish staff priorities, manage monthly data reporting, coordinate and collaborate with multiple departments across the organization, and communicate with stakeholders.

Salary range is Min. $86,320/year to Max. $133,764/year - based on relevant experience

Location : Remote for now, but will need to be in the office three days/week after Covid protocol ends. Office will be in Farmers Branch

Work Schedule

• Full time, day shift

Job Description

Supervise and direct a staff of Quality Auditors; serve as the primary Subject Matter Expert in Quality Auditing and measures specifications:
Determine work goals and track progress of audits; ensure productivity is consistent with the department, company, and provider objectives.
Assign tasks to abstractors/auditors; ensure projects are timely, efficient, and are re-organized as priorities shift.
Oversee management of abstraction and data accuracy, data validation and primary source verification for all SWHR ACO contracts.
Analyze and evaluate weekly metrics to identify Abstractors/Auditors who fall below thresholds and takes appropriate action to address and correct.
Maintain appropriate level of provider assignments/abstractions and audits.
Mentor staff relative to current skills and continued professional growth.

Regulatory Audit Program Submissions and Quality Incentive Program Auditing:
Manage all aspects of the annual SWHR GPRO/HEDIS/MIPS submission, including but not limited to: coordinate clinical staff training sessions on medical record review; retrieve medical records, as necessary, abstracting and entering clinical data, coordinate QA of medical record review process.
Develop and maintain a detailed GPRO/HEDIS project plan to include milestones, tasks, and target/actual dates of completion are met.
Collaborate with analytics to report data for GPRO & HEDIS annually to respective regulator agencies.
Manage and ensure data validation and auditing of SWHR Quality Incentive Programs are complete and submitted in timely manner.
Responsible to manage season staff/vendors to support Regulatory auditing.

Education and Learning:
Subject Matter Expert (SME) in development of the content for Training in partnership with assigned Training resources. This entails a thorough knowledge of the assigned measures, expected outcomes and documentation. On an annual basis, identifies and implements process improvements and necessary changes to ensure each measure is adjusted to reflect internal and external changes.
Prioritize and identify areas of opportunity related to SWHR and its member entities electronic medical records to improve documentation and gap closure utilizing clinical decision support.
Responsible for development of resources, tools and webinars to support SWHR understanding of documentation, measure specifications, etc.
Provide lessons-learned on at least an annual basis, lead a cross-functional team through comprehensive assessment of the prior year's data collection and reporting activities, identify opportunities of improvement of efficiency, and effectiveness.
Identify improvement opportunities and provide recommendations to Director.
Review for compliance and completion of targeted quality measures required for the management of population.

Annual Planning:
Collaborates with Directors to develop annual workplans, goals, projects and initiatives.
Prepare and submit project status reports to Director as often as required.
Create analysis and trend graphs.
Ensures a collaborative work group and works with staff for individual goal setting.
Mentor staff in current skills and continued professional development.
Other Duties as assigned.

The ideal candidate will possess the following qualifications

Education
Bachelor's Degree in Nursing, Business Administration or Public Health required
Master's Degree in Nursing, Business, or Healthcare preferred

Experience
8 years Healthcare experience, including 6 years in healthcare auditing required. 3 years Supervisory experience is required

HEDIS knowledge: data abstraction, auditing, submission, HEDIS educator

Licenses and Certifications
RN - Registered Nurse-Active RN License required upon hire

Skills
Microsoft Office Suite 2010 or newer; Intermediate to advanced Excel
Excellent verbal and written communication skills; outstanding interpersonal skills; the ability to relate positively with individuals at all levels both internally and externally. Proficiency in EPIC and eCW EMR's.
Knowledge of industry standards including but not limited to NCQA, CMS, NQF, AHRQ and HEDIS.
Knowledge of performance improvement processes, change facilitation and synergy principles.
Possess strong analytic and technical skills with the ability to translate complicated data into usable information as well as identify and assess problems. Organizational and time management skills to manage multiple priorities simultaneously and respond to changing priorities.
Problem solving skills, goal driven leader who maintains a productive climate who motivates and coaches employees to meet high performance standards by utilizing sound decision making skills.