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Job description
Quality Gap Closure Support SpecialistPrimary duties to support Quality gap closure activities. This may include calling providers to request medical records, visiting Massachusetts provider offices onsite to collect medical records, scanning and submitting medical records to appropriate health plan stakeholders, review of in-house available medical records, collaboration with several health plan teams to assist in coordinating efforts, outbound calls to members for gap closure activities, additional travel onsite or other duties as assigned.Staff are trained to identify care gaps, review available medical records in Epic and CCA systems, request additional medical records via phone and fax, document all efforts and retrieved records in CCA and provide evidence to close care gaps; Staff also make calls during the Q4 push to outreach Non-Utilizers offering a Care Connections visit or assistance scheduling an appointment with their PCP. Staff will outreach PCP offices via phone and fax concerning interventions for OMW, EED and BCS measures. Staff facilitates warm transfers to pharmacy team for members who require medications refills.Must Have Skills:Associate's degree or equivalent combination of education and work experience.1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experience.Working knowledge of Quality metrics and risk adjustment practices across all business linesDemonstrates data analytic skillsOperational knowledge and experience with PowerPoint, Excel, VisioEffective communication skillsStrong leadership skillsExcellent attention to detail, accuracy, and timelinessExperience with project management and coordination among several teamsDay to Day Responsibilities:Operationally, the staff performs provider outreach via phone calls and faxes for preventative measures and focuses on BP and HbA1c measures in Q4. The staff facilitates transparency of care gap information via record upload in CCA and "FYI tasks" between Care Connections and SWH NCM. To assist other Molina HEDIS efforts, the staff requests, retrieves and uploads needed medical records into a designated area for Molina abstractors to review. Additional travel onsite or other duties as assigned.Required Years of Experience: 1-3 years experience in healthcare with minimum 1 year experience improving provider Quality performance through provider engagement, practice transformation, managed care quality improvement, or equivalent experienceRequired Licensure / Education: Associate's degree or equivalent combination of education and work experience
Worksite address
waltham, MA, 02451, US
Who can apply
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