SUMMARY OF RESPONSIBILITY:

The SoNE HEALTH Quality Data Coordinator works in concert with SoNE HEALTH physicians and their staff, acting as an educator and resource, to assist, guide and support them through their participation in payor-driven financial incentive HEDIS review programs for Commercial, Medicare and Medicare Advantage carriers. Strong organizational skills and attention to detail is essential. Facilitates the identification of patients lacking early detection and regular preventative screenings, assisting providers to better manage chronic illness utilizing tools and reports from payors and in-house resources. Performs on-site or in-field chart review and abstractions of pertinent documentation that supports the physician’s clinical effort to complete all appropriate assessments and quality testing for patients. Collaborates closely with payors, providers and patients, in order to promote the completion of required screenings and assessments resolving barriers to compliance. Educates providers and staff on national quality metrics, such as HEDIS and STAR measures, and recommends and assists with strategies to enhance performance levels. Supervises temporary or per diem personnel hired for the annual Accountable Care Organization review including education on quality metrics, various provider electronic medical record systems and claim submission platforms. Creates and preforms presentations at meetings and conferences and provides instruction on over forty various provider electronic medical record systems and submission platforms. Outreaches to patients with gaps in care; may assist with scheduling patients for appointments with providers or specialists. Promotes a positive, professional, cooperative working environment and population management team approach.

This role is located at the company's headquarters in Hartford, CT, and operates in a hybrid environment.

ESSENTIAL FUNCTIONS:

• Facilitates the identification of patients lacking early detection, regular prevention screening and managing chronic illness.

• Utilizes the payor and in-house resources reports, spreadsheets and patient assessment forms that identify potential patient gabs in care and goals for achieving maximum performance.
• Reviews and abstracts pertinent documentation to support the clinical physician efforts to complete all appropriate screening and tests for patients.
• Interprets and reviews medical data in various EMR systems and paper charts.
• Collaborates with physicians and practice staff on the findings of the review and steps needed to fulfill the required screening/testing.
• May outreach to patients to close gaps in care and assist with booking health care appointments
• Submits completed data for payment, identifies and resolves rejections, problem solves with vendor any issues that inhibit productivity and success of the program.

• Educates providers on various national quality benchmarks such as HEDIS and STAR measures.
• Enhances the understanding of integrated care coordination through SoNE.
• Supervises temporary or per diem personnel hired for the annual Accountable Care Organization (ACO) review.

• Develops written materials encompassing HEDIS 5 Star Quality metrics as described by NCQA
• Presents educational and marketing material to provider groups during events sponsored by SoNE HEALTH.
• Creates and performs presentations at meetings and conferences.
• Problem solves barriers to exceptional performance by formulating action plans to assist physician groups to close gaps in case.
• Reviews office work flows and shares Best Practices

• Recognizes each patients’ rights by providing confidentiality of patient information according to established policy and accepted professional standards.
• Serves as a liaison and resource for the physician, payor, and healthcare team to facilitate appropriate quality standard-based care.
• Collaborates effectively and efficiently with all internal and external stakeholders i.e. physicians and their office staff, payors and SFHCP personnel to maximize opportunities to improve outcomes for all of our patients.
• Contributes in establishing and maintaining Quality Data Service Program goals/objectives as evidenced by participation in department meetings and projects.
• Seeks educational opportunities for on-going professional development with an emphasis in Stars/HEDIS Quality Improvement and other Process Improvement Methodologies
• Has a solid understanding of value-based care models.
• Performs other tasks/duties as assigned by manager.
• Promotes a professional image with all interactions and functions

• Educates employees on MSSP ACO quality metrics and assists in the development of training program development.
• Provides instruction on over forty various provider electronic medical record systems and submission platforms.
• Contributes to establish goals for individuals and teams based on resources and time allotted for project completion.
• Ensure compliance for all quality audits

Other Functions:

• Performs other duties as assigned.

The duties listed above are intended only as illustrative of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar or a logical assignment to the position.

QUALIFICATIONS AND COMPETENCIES:

• BA/BS in Business Administration or Healthcare Administration or equivalent experience
• Medical Assistant/LPN Certification or equivalent preferred
• 3+ years of healthcare related experience with HEDIS and Stars, CAHPs and HOS
• 3+ years of experience in quality improvement and/or population health management
• 5+ years of experience utilizing Excel and other data reporting tools
• 3+ years within a data driven, healthcare environment and/or healthcare-related field.
• Epic experience preferred along with other EHR/EMR platform experience
• Knowledge of quality improvement processes, data collection, Microsoft Office with an emphasis on spreadsheets, and project management tools and outcome analysis preferred.
• This position requires highly developed communication and interpersonal skills, self-direction and problem-solving skills. Excellent organizational and interpersonal skills required, with the ability to communicate and work collaboratively with all levels of SoNE staff, payors, providers and office staff, and effectively utilizing all resources available. Must be adaptable to unpredictable situations in a patient care setting while effectively managing assigned duties with precise attention-to-detail, accuracy and excellent follow-up and follow through, with minimal supervision.
• Maintains strict confidentiality with patient information in a professional manner.
• The ability to use basic computer software and Microsoft Office applications, including spreadsheets, is required.
• Current and valid Driver’s License
• Previous telecommuting experience

PHYSICAL AND MENTAL REQUIREMENTS:

The Physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to work long hours – over eight in a work day, and over 40 in a work week as necessary;
• Regularly required to use hands to finger, handle or feel objects, tools, or controls; reach with hands and arms; and talk or hear.
• Frequently is required to walk and sit.
• Occasionally required to stand; climb or balance; and stoop, kneel, crouch or crawl.
• Ability to lift and/or move up to 20 pounds.
• Vision abilities required by this job include close vision, color vision, peripheral vision, depth perception and ability to adjust focus.
• The dexterity necessary to utilize a computer keyboard on a regular basis is essential.

ADDITIONAL REQUIREMENTS:

As a condition of employment at SoNE HEALTH and for the safety and well-being of our employees, all employees are required to be fully vaccinated for influenza and COVID-19.