Quality Reporting Lead

Apply on line at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture, which is positively reflected into the communities we serve.

The Opportunity:

The Quality Reporting Lead has primary responsibility for oversight of efficient quality measures collection and reporting including Healthcare Effectiveness Data & Information Set (HEDIS), STARS, CAHPS, HOS, and MEDQUEST Pay for Performance (P4P). This position is also responsible for planning and processing all required quality data collection and reporting to ensure complete, timely and accurate data reporting according to contract requirements and accreditation standards. This includes the support of vendor contracts, and the HEDIS and related audits. The Lead supports the HEDIS Roadmap throughout the year, including functions such as timely notification of status changes to NCQA/HSAG, and meeting required pre-reporting and reporting checkpoints with all relevant internal and external stakeholders. The Lead is serves as a HEDIS subject matter expert and with the Quality Improvement Manager, provides guidance on measure specifications, changes and trends. They will develop tools and trainings that help other quality and provider relations staff to work with providers and networks to drive improvement

Under direction of Quality Improvement Manager the Quality Reporting Lead leads the implementation of projects to support AlohaCare’s Quality Strategy. This includes the development, implementation and maintenance of member and provider facing initiatives, interdepartmental quality projects and solutions aimed at improving targeted measures. The Lead may design new processes and workflows aimed at improving quality and support implementation of these.

Primary Duties and Responsibilities:

• Responsible for developing and executing operational objectives for each project plan and oversight of day to day activities through action plan development, process implementation and ongoing quality/productivity metrics monitoring in order to promote operational excellence and identify opportunities for departmental and organizational improvement.
• Trains and mentors the HEDIS Abstractors and other staff as needed; selects, trains and mentors QI retrieval and abstraction contractors to include delegation of work activities, coaching, goal setting and project management guidance.
• Oversee the planning, development, implementation and day-to-day operations of HEDIS.
• Subject matter expert in NCQA, CMS and Med-QUEST reporting requirements, HEDIS technical specifications, CAHPS specifications, Medicare Star Ratings technical specifications, software vendor requirements, auditor requirements, and other related requirements to assure timely compliance and completion of the project plan.
• Coordinate and support the following activities for Quality Improvement and HEDIS: project schedule management, audit management, and reporting.
• Administers collection of non-standard supplemental data from PCPs and other sources and for integrating supplemental databases with HEDIS software, ensuring that NCQA requirements are met.
• Investigate, review, recommend, communicate and implement solutions, which identify problems/root cause of issues. Communicate to the appropriate up line management as needed.
• Maintain lines of communication to discuss/review project status, barriers and results of analysis to management and key stakeholders via reports/presentations and assist management in implementing programs that provide solutions.

Additional Responsibilities:

• Maintains current internal AlohaCare policies, manuals, reference materials and procedures that are compliant with external agency guidelines and support operational efficiency.
• Other duties as required
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

Requirements:

• Associate’s Degree in Health Care Administration, Nursing, Long Term Services and Supports, Public Health, or related field
• 1-3 years of lead experience and or oversight of related areas.
• 1-2 years’ prior experience with HEDIS medical record review and HEDIS data software and reporting required.
• Strong verbal and written communication in English.
• Requires operation of general office equipment to include; PC, fax/copy machine and ACD Midel Phones.
• Advanced skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Ability to multi-task, adapt to changing priorities, manage a diversity of high priority projects in a fast-paced environment.
• Ability to problem solve, analyze, think critically, good judgment and make fair decisions.
• Ability to motivate, coach, lead, develop and supervise subordinates effectively.
• Ability to manage complex projects
• Ability to work as part of a team on a time sensitive projects
• Ability to work independently with minimal supervision.
• Professional phone étiquette and excellent verbal communication
• General understanding of healthcare privacy regulations

Preferred Licensure/Certification/Education:

• Licensed RN
• CPC, CRC or other coding certification

Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC

Salary Range: $60,000 - $83,000 annually

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.