Job Summary: As a Quality Specialist, you will play a vital role in ensuring comprehensive patient care by facilitating various outreach activities and administrative tasks to support quality initiatives throughout the organization. 

Essential Duties and Responsibilities: 

•    Conducting data mining to identify care gaps, particularly in cancer screening and diabetes management.

•    Engaging with patients to schedule and coordinate appointments for essential services such as Chronic Disease Education (CDE) and Transitional Care Management (TCM).

•    Inputting patient data accurately into insurance portals to facilitate seamless healthcare operations.

•    Coordinating referrals to external healthcare providers as needed for specialized care.

•    Managing outreach initiatives to ensure patients adhere to recommended care plans, including medication adherence and follow-up visits.

•    Collaborating with insurance payers and organizations like Aledade to optimize patient care pathways and enhance health outcomes.

•    Retrieving and organizing hospital records to support continuity of care and medical decision-making.

•    Facilitating reporting requirements such as NCQA and MSSP reporting to maintain regulatory compliance.

•    Monitoring and documenting patient adherence to preventive health measures such as Annual Wellness Visits (AWV) and recommended screenings.

•    Verifying prescription status with pharmacies and facilitating medication orders as necessary.

•    Coordinating appropriate diagnostic testing based on healthcare provider recommendations.

•    Providing support to healthcare providers and clinic staff to address patient needs effectively.

•    Maintain compliance with the organization’s confidentiality policy in accordance to the Health Insurance Portability and Accountability Act (HIPAA).

•    Maintain compliance with all company policies and procedures 

•    Other duties as assigned. 

Education and/or Work Experience Requirements: 

•    High school diploma or GED required; Bachelor's degree in healthcare administration, public health, or related field preferred.

•    Prior experience in healthcare coordination, outreach, or patient advocacy roles is advantageous.

•    Proficiency in using electronic health record (EHR) systems and insurance portals.

•    Strong communication skills, both verbal and written, with the ability to engage effectively with patients and healthcare stakeholders.

•    Detail-oriented with excellent organizational and multitasking abilities.

•    Knowledge of healthcare regulations and quality improvement initiatives is desirable.

•    Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service

•    Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices

Physical Requirements/Working Conditions: 

•    Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards. 

•    Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards

•    Must be able to talk, listen and speak clearly on telephone