JOB SUMMARY

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Accountable for providing project help by gathering data, conducting research, maintaining records and tracking issues. Performs and helps in studies and initiatives related to HEDIS/Medical Data Collections, Scott and White Health Plan (SWHP) QI studies and initiatives. Works directly with the SWHP Quality Improvement Manager and QUI Coordinators to plan, organize and give help for QI studies and initiaives for SWHP.

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ESSENTIAL FUNCTIONS OF THE ROLE

\n\nMonitor and evaluate data to identify areas of quality and performance improvements.\nPerforms data collection using various sources, including retrospective review of medical records, focusing on reliability of resulting data.\nMedical record abstraction for NCQA HEDIS medical record review project (January-May).\nClearly document information to help findings with action plan and conclusions.\nExamines data by doing appropriate drilldowns into the data and using various continuous quality improvement tools, focusing on identifying explanations for variation and opportunities for improvements.\nHelp improvement in the overall quality and completeness of medical records documentation by indentifying educational opportunities to address deficiencies.\nGather data and prepare documents to submit to regulatory agencies to ensure compliance.\nPrepare and maintain documents for NCQA, TDI, CMS and HHSC surveys to be in full compliance.\nMaintain accurate documentation of all QI activities and prepare reports as required.\nAssure all QI activities are documented, and reported within the organization and externally as appropriate.\nMaintain the confidentiality, integrity and security of all documents in full compliance with SWHP.\nHelp the accomplishment of corporate strategic plans that achieve high impact and significant improvements in organizational performance.\nCoordinate and conduct assignments to give administrative help to QI and clinical analytics teams.\nContribute to quality improvement activities including but not limited to the following; HEDIS, HOS, CAHPS reporting, customer satisfaction survey results, peer review, health promotions, quality of care and quality of service monitoring, coordination with regulatory agencies, focused quality improvement studies, clinical protocol and guideline updates.\nAccurate recording of meeting minutes and other documentation essential for the overall completion of the QI projects.\nPrepare and distribute accurate and timely reports according to department, documentation standards, and regulatory requirements.\nHelp QI Coordinators in collecting data and preparing reports for the annual program evaluation and QI work plan.\nPerform other position appropriate duties as required in a competent, professional and courteous way.\n\n

KEY SUCCESS FACTORS

\n\nAssociates degree (two-year program) or equivalent formal training program in a health related field preferred.\nQuality Improvement/Assurance, Healthcare or other Managed Care related field is preferred.\nProficient in Microsoft Office Suite, including but not limited to, Outlook, Word, Excel, Access and Power Point.\nExcellent written and verbal communication skills, as well as attention to details and deadlines.\nDemonstrates problem solving, leadership, conflict management and team building skills to ensure a productive work environment to achieve goals.\nSkilled in data reasoning, interpreting and evaluating information and have the ability to work in a fast paced, deadlines motivated environment.\n\n

BENEFITS

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Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

\n\nImmediate eligibility for health and welfare benefit\n401(k) savings plan with dollar-for-dollar match up to 5%\nTuition Reimbursement\nPTO accrual beginning Day 1\n\n

Note: Benefits may vary based on position type and/or level

QUALIFICATIONS

\n\n\n\tEDUCATION - H.S. Diploma/GED Equivalent\n\tEXPERIENCE - 1 Year of Experience\n