Quality Improvement Analyst - TMCOne

SUMMARY:

Responsible for data collection of Organization’s provider practices for quality measures as defined by Accountable Care Organization and payers. Works closely with Quality Improvement and Clinical Outcomes Manager, Quality Improvement and Clinical Outcomes Manager Specialist, Practice Manager, Revenue Cycle Manager and Epic Amb Department to ensure correct configuration of EMR system and reporting functions meet quality care requirements.

ESSENTIAL FUNCTIONS:

Creates and communicates status reports in accordance with departmental standards.

Updates documentation consistently, following departmental policies and procedures.

Provides routine interaction with physicians, providers, and coding staff on a daily basis to assist with or resolve issues relating to medical documentation, coding, quality improvement, and clinical outcomes associated with patient care and service to ensure positive results.

Prepares detailed reports that provide a range of data to assist management in evaluating performance and making recommendations for Accountable Care Organization reports: HEDIS, GPRO, etc.

Assists with EPIC system analysis and report authorship and design.

Assists with analyzing business operations and provides recommendations for optimum EPIC system utilization.

Develop dashboards, reports and analytical models. 

Meets with customers and provides frequent written status updates to customers, team members, and department management.

Responsible for providing superior customer service while reviewing and processing information requests including medical records from patients, physicians, other medical professionals, insurance companies and others.

Coordinates, monitors and maintains the credentialing and re-credentialing process.

Adheres to TMC and TMC One organizational and department-specific safety, confidentiality, values, policies and standards.

Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication. 

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:  Completion of a 2-year college or an equivalent combination of relevant education and experience. Bachelor’s degree from an accredited institution in a related field preferred or equivalent experience in a related field preferred.

EXPERIENCE: Five (5) years of physician office and clinic operations experience. Five (5) years of related data management and reporting. 

LICENSURE OR CERTIFICATION:  None required.

KNOWLEDGE, SKILLS AND ABILITIES: 

• Knowledge of federal and state requirements as it relates to medical insurance to include Medicare and Medicaid.

• Knowledge of electronic medical records systems, specific experience with EPIC beneficial.

• Skill in computer applications such as basic functionality of the computer, PC File and Folder, Word, EXCEL, Outlook and PowerPoint.

• Ability to read and interpret documents, contracts, proposals, and related legislation.

• Ability to prepare detailed reports and correspondence.

• Ability to listen and accurately interpret others’ communication or instructions and take appropriate action.

• Ability to speak effectively before groups of employees or customers.

• Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs; ability to apply basic algebraic concepts.

• Skill in assessing needs and determining through documentation what the best approach might be.

• Ability to maintain professional working relationships and communication with providers, clinical staff and business office staff, and administration.

• Ability to resolve conflict using judgment, tact, and diplomacy.

• Ability to write correspondence and effectively present information in one-on-one and small group situations to providers, and other employees of the organization.

• Knowledge of medical terminology and coding related to professional billing such as, CPT-4 codes, ICD-9, ICD-10, and HCPCS codes.

• Knowledge of medical records and the evaluation of medical records for out-patient services.

• Ability to identify problems and recommend operations solutions.

• Ability to analyze, interpret, prepare, and present reports to management.

• Ability to accurately perform multiple tasks and observe strict deadlines.