Quality Improvement Data Coordinator Medicare Advantage

As outlined below provide quality improvement focused work for all delegated entities and support for ACO quality reporting for all contracted ACOs.

WHAT YOULL BE DOING

• Work in a partially remote environment collaborating with team members virtually each day.
• Serve as a Subject Matter Expert (SME) on quality improvement measures customer needs and payerspecific quality initiatives across commercial and government programs.
• Travel to provider offices to support quality efforts including completing onsite eye exams (training provided) scanning records and coordinating medical record management.
• Conduct proactive patient outreach to identify and close quality gapseducating patients scheduling screenings supporting treatment plan adherence and improving outcomes.
• Collect and abstract quality data using EMRs claims information and provider engagement.
• Use multiple platforms daily including EMR systems payer portals vendor tools GuideHealth applications and Microsoft 365 (Excel Word PowerPoint Teams).
• Work with various health data sources including patient lists gap lists and medical records.
• Apply all available quality resourcesNCQA/HEDIS specifications coding materials and Guidesto ensure accuracy and completeness.
• Prioritize tasks to meet strict reporting timelines and quality program requirements.
• Communicate performance trends barriers and improvement strategies to internal teams and external partners.
• Follow established QI workflows processes and best practices.
• Collaborate daily with customers payers and internal teams.
• Participate in payer and departmental trainings webinars and support calls.
• Represent GuideHealth professionally and build positive working relationships with providers and staff.

Qualifications :

WHAT YOULL NEED TO HAVE

• Associate degree or higher or a clinical license/certification (CMA LPN).
• 13 years of healthcare experience including EMR use medical terminology chart review and familiarity with quality measures or billing/coding.
• Minimum 2 years of Medicare Advantage quality data abstraction and patient outreach experience.
• Strong technical abilitycomfortable working with health data Excel PowerPoint and multiple digital systems.
• Excellent verbal and written communication skills.
• High attention to detail strong organization and the ability to meet strict deadlines.
• Ability to work collaboratively across teams and with external partners.
• Valid drivers license and personal vehicle; travel required and reimbursed.

WOULD LOVE FOR YOU TO HAVE

• Certified/licensed professional-CMA LPN
• Knowledge or experience in quality improvement initiatives and data submissions required by various health insurance payers.
• Extensive experience with quality database entries and reporting.
• Experience in interpreting and reporting quality information as well as training staff.
• Proficiency in Electronic Medical Record (EMR) software and cloud platforms

WHAT YOU GET

• Use your skills to make a meaningful impact in healthcare.
• Work with a great team in an awesome work environment.
• Competitive compensation.
• Great benefits like flextime time off.

Additional Information :

The base pay range for this role is between $28-$32 per hour paid bi-weekly

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth our values come to life in everything we do. 

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike. 
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve. 
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical Dental and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those just in case moments. Additionally we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy data security and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

Remote Work :

No

Employment Type :

Full-time