Changing health care
to improve quality of
life for all.
Beth Israel Lahey Health’s roots in providing top-quality health care date back nearly a century. We're fully committed to ensuring our patients receive the care they deserve. As a leading healthcare provider throughout New England, we aim to change the current state of health care for the better and make lasting improvements that guarantee access to our services.
Quality Audit Analyst HEDIS
Wakefield, MassachusettsOrganization Facility: Beth Israel Lahey Health Performance Network Category: Quality Job ID: JR4210 Date posted: 11/02/2022
When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Work Shift:Day (United States of America)Reporting to the Manager of Quality, the Quality Audit Analyst works with various electronic health record and quality reporting systems to collect information from patient records and investigate discrepancies between medical record documentation and data reporting systems in support of BILHPN's quality and clinical programs and contractual obligations. The analyst is responsible for overseeing processes which assure the quality and integrity of data reported to various health plans and other stakeholders. This position also serves as the primary resource for collecting clinical data not available in BILHPN reporting systems. The analyst will utilize strong knowledge of healthcare quality measurement criteria and EHR systems to ensure the accuracy and completeness of quality measure submissions.
1. Serves as a central resource to the BILHPN Quality department in the collection and submission of quality data to health plans through coordinating data collection with various physician practices and hospitals and locating data in electronic health records. (essential)
2. Uses knowledge of electronic health records and quality measurement (HEDIS, AHRQ or Medicare Share Savings Quality Measures) to quality check that data submitted to payers is accurate and complete. (essential)
3. Interprets population health level reports to identify care gaps and missing data. (essential)
4. Implements various appeals processes. (essential)
5. Understands and can clearly communicate, both verbally and in writing, clinical quality measure components of global payment contracts and EHR Use Requirements and can develop tools in support of collecting data that meets those requirements. Keeps current on quality measure specifications and communicates variations as appropriate. (essential)
6. Documents project status, process workflows and technical details of all payor quality audits.
7. Other duties as assigned by the Director of Quality and Performance Improvement and the Manager of Quality.
Education: Bachelor’s degree or 3-5 years related experience required in healthcare and familiarity with standard quality measures.
Strong knowledge and experience with HEDIS ambulatory quality measures required.
Ability to travel locally throughout Massachusetts and Southern New Hampshire.
Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint, and other web-based applications.
May produce complex documents, perform analysis, and maintain databases. Knowledge of electronic medical record, including eClinical Works, Athena, GE Centricity, and/or Epic.
Skills, Knowledge & Abilities: ·
Ability to make decisions that are guided by general instructions and practices requiring some interpretation.
May make recommendations for solving problems of moderate complexity and importance. ·
Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents. ·
Ability to follow precedents and procedures.
May set priorities and organize work within general guidelines.
Seeks assistance when confronted with difficult and/or unpredictable situations.
Work progress is monitored by supervisor/manager. ·
Ability to communicate clearly and effectively in written English with internal and external customers. ·
Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers. ·
Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations. ·
Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members. ·
Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving.
Ability to remain calm in stressful situations.