Job Summary: The Quality Improvement Coordinator is responsible for auditing and analyzing pay-for-quality data to ensure accuracy and support performance improvement efforts. This role collaborates with internal teams and external partners to close care gaps, assist with patient outreach, and enhance quality reporting. Key duties include generating survey and performance reports, supporting PCMH certification, validating UDS and HEDIS data, and contributing to process improvements across departments.
Essential Duties & Responsibilities
- Synthesize, review, and audit pay-for-quality data from insurance carriers.
- Analyze pay-for-quality data for inconsistencies via EMR and billing audits, may assist Quality Improvement Manager in summarizing findings and preparing reports as needed.
- Participate in ongoing collaborations with health insurance plans to ensure accuracy and timeliness of data and reports.
- Regularly collaborate with the Care Coordination team to close gaps in care and maximize outreach efforts. This may include direct patient outreach as needed to support the closure of care gaps.
- Generate patient satisfaction survey reports for all sites and assist in the creation of summaries/infographics using patient satisfaction survey data collected.
- In collaboration with the Quality Improvement Manager, collect and submit documents required for PCMH certification/recognition. Create and validate PCMH reports and conduct PCMH audits.
- Create and run quarterly Peer Review reports.
- May assist with the development of reports for various departments, programs, and grants at PCC.
- Validate UDS quality reports; assist with other UDS data manipulation and analysis as needed.
- Monitor incoming HEDIS requests and submit appropriate documentation when applicable.
- Recommend and implement solutions for existing processes; participate in planning, development, and evaluation of solutions and processes.
- Collaborate closely with staff and external organizations as needed.
- Perform other duties as required and assigned.
