HEDIS Specialist

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    "requisitionDescription": "<div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><link href=\"https://cdn.jsdelivr.net/npm/[email protected]/css/froala_editor.pkgd.min.css\" rel=\"stylesheet\" type=\"text/css\">&nbsp;<link href=\"https://cdn.jsdelivr.net/npm/[email protected]/css/froala_style.min.css\" rel=\"stylesheet\" type=\"text/css\"><div class=\"fr-view\"><div><div><p>Borinquen Medical Centers is based in Miami, Florida and is seeking to hire a full-time HEDIS Specialist to join our team. <span style=\"font-size: 13.3333;\">This position is responsible for communicating provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered to meet and exceed HEDIS &amp; P4P measures. Responsible for verifying and updating patient registration information, including insurance, demographic and patient data. Work collaboratively with all Departments to resolve registration issues. Support QI, Policy &amp; Procedures and the Care team. This member of the Care team will be in charge to ensure patients comply with disease management goals (Pre and post call documentation), documenting in the E.H.R. to ensure continuity of care. The quality care person will provide reports on these activities on a daily, weekly and monthly basis to the QI Manager dependent on the E.H.R. data entered and HEDIS.</span> This position is also responsible for t<span style=\"font-size: 13.3333;\">racking patient number of visits attending BMC and ensuring access to care by minimally following standard care guidelines.</span></p><p><span style=\"font-size: 13.3333;\"><ins>TASKS AND RESPONSIBILITIES</ins></span></p><ol><li><span style=\"font-family: Tahoma, sans-serif;\">Coordinating and completing HEDIS quality specific projects ensuring consistency with BMC strategy, commitments, and goals.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Obtain patient roster from participating health insurance plans.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Call Patients that are Registered to set an appointment; Evaluate Quality Management Tab, Avhana &amp; HEDIS.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Validate roster; Schedule appointments and ensure compliance with quality measures.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Track Quality measures and sell BHCC services if needed and determine reason for appointment.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Track Medicare population utilization.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Assist with Chronic Care management (CCM) Share medical Appointments; Complete Care Gaps; Assist with group visit.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Track hospitalization discharges and bring the patients for continuity of care.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Proactively seek resources to identify gaps on existing or quality projects as they arise.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Performs other analyses to assist with documentation.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Periodically audit records to confirm compliance with HEDIS and NCQA standards.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Ensures that all scheduled and tracking attended patients fulfill their care gaps and documents barriers of patients to do so.</span></li><li dir=\"auto\"><span style=\"background-color: white;font-family: Tahoma, sans-serif;\">Responsible for verifying and updating patient registration information, including insurance, demographic and patient data when scheduling appointment.</span></li><li dir=\"auto\"><span style=\"background-color: white;font-family: Tahoma, sans-serif;\">Maintains internal rosters to mitigate inadvertent leakage resulting from incorrect listings.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">The ability to retrieve,</span> <span style=\"font-family: Tahoma, sans-serif;\">communicate, present data and information both verbally and written.</span></li><li dir=\"auto\"><span style=\"background-color: white;font-family: Tahoma, sans-serif;\">Provides paneling information provided to Health Plans is accurate and timely.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Coordinates with Quality Manager on a weekly basis.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Chart Audit: Internal and External Chart Audits when requested.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Perform and track call campaigns for non- compliant patients to increase access to care.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Increase and track access to care for patients that have not attended in the last six months their primary care provider visit.</span></li><li dir=\"auto\"><span style=\"font-family: Tahoma, sans-serif;\">Provides patients with covered benefits and services that their primary health plan offers.</span></li></ol><p><span style=\"font-family: Tahoma, sans-serif;\"><ins>REQUIREMENTS</ins></span></p><ol><li id=\"isPasted\">Associates college degree</li><li>Well organized and Bilingual (Spanish and/or Creole).</li><li>Computer literacy with proficiency and expertise in Microsoft Office, including Outlook, Word, and Excel.&nbsp;</li><li>Ability to interact effectively with patients, administration, faculty, and staff.</li><li>Handle information with high level of confidentiality.</li><li>Considerable knowledge of standard concepts, practices, and procedures within a field.</li><li>Relies on limited experience and judgment to make decision, plan and accomplish goals.</li><li>Minimum 1 year of customer service.</li><li>Strong interpersonal skills.</li><li>Bachelor&rsquo;s Degree.</li><li>Experience in clinical background setting (LPN, MA) with case management experience.</li></ol><p><ins>BENEFITS</ins></p><ol><li style=\"text-align:start;\"><span style=\"color: rgb(75,75,75);background-color: rgb(255,255,255);font-size: 14px;font-family: Helvetica Neue;\">Medical/Dental/Vision/Short Term Disability</span></li><li><span style=\"color: rgb(75,75,75);background-color: rgb(255,255,255);font-size: 14px;font-family: Helvetica Neue;\">Company paid long term disability</span></li><li><span style=\"color: rgb(75,75,75);background-color: rgb(255,255,255);font-size: 14px;font-family: Helvetica Neue;\">Life insurance</span></li><li><span style=\"color: rgb(75,75,75);background-color: rgb(255,255,255);font-size: 14px;font-family: Helvetica Neue;\">401K Plan</span></li><li><span style=\"color: rgb(75,75,75);background-color: rgb(255,255,255);font-size: 14px;font-family: Helvetica Neue;\">Standard Paid Holiday&#39;s</span></li><li><span style=\"color: rgb(75,75,75);background-color: rgb(255,255,255);font-size: 14px;font-family: Helvetica Neue;\">Vacation and Sick Time</span></li><li><span style=\"color: rgb(75,75,75);background-color: rgb(255,255,255);font-size: 14px;font-family: Helvetica Neue;\">Amazing Team &amp; Atmosphere</span>&nbsp;</li></ol></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>\n",
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