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HEDIS / GPRO Specialist

Do you love being ranked #1 and have the competitive spirit to get everyone around you to achieve this goal?

Do you enjoy building and maintaining relationships to get results?

Are you tech savvy?

Are you passionate about learning and teaching?

Are you a master of prioritization?

Do you have OCD for accuracy and completeness?

Do you like wearing many hats?

 

If yes, COME JOIN US!!  If you have the right attitude and aptitude, we will invest in you and train you on the subject matter.

 

OUR CULTURE - 5 STAR SERVICE

At Physician Partners, we give you the power to transform lives.  Working together as a team to shape the future of healthcare, we are at the forefront of innovation and best practices to improve the health of our communities. Our team provides the platform, technology solutions and new health programs in a collaborative environment to our primary care providers with the sole purpose of achieving Better Health. Our commitment, our passion and our culture sets us apart from others and is the cornerstone of everything we do. Our team settles for nothing less than a new and profoundly better way of delivering truly proactive health care rather than simply building a better version of the same old reactive sick care model that serves our communities today.

THE OPPORTUNITY

We are currently searching for a highly engaged, self-motivated, enthusiastic, and service-oriented team member who will assist our network of primary care providers with all things Stars, HEDIS, and GPRO. The ability to work in a fast-paced environment with strong attention to detail, willingness and ability to travel to different provider offices across central Florida, and a burning desire to succeed are essential.

THE WORK

The goal for this role is to ensure that providers appropriately, timely, and comprehensively complete the required steps to satisfy the requirements of Stars / HEDIS / GPRO quality metrics. Below are the components this role will handle on a day-to-day basis.

Provider Support

  • Establish positive, consultative relationships with assigned Physician offices
  • Travel to assigned provider offices as needed for meetings, education, training, and record retrieval (depending on panel size, but at least once a month)
  • Methodically analyze and communicate quality scores and gaps to providers
  • Develop comprehensive, provider-specific plans to increase their Stars / HEDIS / GPRO performance and improve their outcomes by resolving quality gaps
  • Work with provider offices on education, documentation, and submission to plans
  • Assist provider offices to setup EMR templates and checklists
  • Provide administrative and telephonic support to provider offices as needed
  • Medical Records Review
  • Review and abstract medical records from EMR and / or paper charts
  • Ensure that documentation complies with appropriate requirements
  • Submit abstracted documentation to health plans through appropriate methods
  • Document all records and submissions into a central database on a daily basis

Coordination

  • Coordinate with health plans, vendors, etc. to complete assigned projects / tasks
  • Coordinate with offshore team to oversee review, extraction, and submission
  • Coordinate events (including patient scheduling) such as mobile eye exams
  • Coordinate with other departments team members on quality related tasks

General

  • Function as quality / HEDIS subject matter expert
  • Participate in ad-hoc, time-sensitive, and other projects and tasks, as assigned
  • Work independently in clinical settings
  • Be able to problem solve, use best professional judgment and apply critical thinking techniques to resolve issues as they arise

REQUIRED / PREFERRED QUALIFICATIONS

  • Bachelor’s preferred
  • Associates or high school diploma considered
  • Previous work experience in Stars / HEDIS / GPRO preferred
  • Previous work experience in a primary care outpatient clinic highly desired
  • Knowledge of medical terminology essential
  • Must have excellent communication skills - verbal and written
  • Must have reliable transportation to travel to assigned provider offices
  • Must have working knowledge of technological tools including MS Office and GSuite, especially Word / GDocs, Excel / GSheets, and PowerPoint / GSlides

DETAILS

  • Full time position of 40 hours plus per week
  • Full benefits (Medical, Dental, Vision, Life Insurance, paid vacation, and 401k)
  • Bonus opportunity 
  • Excellent growth potential
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