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Manage the planning, execution and evaluation of QIHEP initiatives, HEDIS and practice transformation provider projects from initiation/pilot phase through project closure to improve quality performance, SCFHP's HEDIS scores, and other quality metrics.
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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. 3+ years of experience in HEDIS record collection and risk adjustment (coding.
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Provide educational support to physicians and staff to ensure process improvement and increase member satisfaction, member retention, continuity of care and drive HEDIS and QARR improvement activities.
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Assist in reviewing medical records and documents and abstract clinic data for HEDIS reporting, meet daily goals and upload information to payer portals. Documenting findings in applicable HEDIS databases, spreadsheets and prescribed cloud-based platforms.
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Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
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The CHW assists with the company’s HEDIS measurement goals by providing personalized support to help members achieve good health practices. Support the members’ Individual Services Plans and Crisis/Safety Plans.
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Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
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Actively manage all aspects of APP care: medical decision making, specialty consults, home health and hospice referrals and review minimum of 5% of APP charts for clinical care (emphasis on medication optimization, palliative care/advance directives) and appropriate HCC/HEDIS exclusion documentation.
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The organization exceeds the 90th percentile in most HEDIS measures, is among the top provider groups nationally in patient experience and provides care at a cost well below market competitors.
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At least 3 years of experience in population health, quality, HEDIS, chronic care management, or a similar environment. This position will serve as a member of the Value-Based Care (VBC) team at Alo Solutions.
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At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Reliant Medical Group, part of the Optum family of businesses, is seeking an Internal Medicine Physician to join our growing care team in Auburn, Massachusetts.
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Current HIM or Coding Certification (AAPC, AHMIA or another national agency) Working Knowledge of PCMH and HEDIS reporting; and proficiency in the use of Window Based PC system and a range of software packages, including Microsoft Outlook.
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Experience with Quality Management (HEDIS, IHA AMP, IHA STARs) The Director will develop pathways for patients and network providers to efficiently access agent support teams for inquiry and problem management.
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Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards.
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Familiar with HRSA, HEDIS, Government HealthCare practices, and general Population Health Analytics. Apply knowledge of the broad principles of health and clinical informatics, clinical systems, and healthcare processes at the point of care to enable decision-making and support for CCI.
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hedis job Title: decision support analyst Company: Highmark Health
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