Qi Specialist Ii (Hedis

QI Specialist II (HEDIS)

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Location:

Irving, TX Duration: 3+ Months (Temp to Perm)

Duration:
Possibility to be extended beyond initial 90 days and if the agent has great attendance and performance. In addition, they will be evaluated for a potential perm role.

Bilingual is a plus but not a must. There is travel:
They will be visiting local provider offices to pick up medical records or performing audits on those offices. All candidates need a valid unrestricted driver's license. Establishes and fosters a healthy working relationship between community physician practice. Educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Provides education for HEDIS measures;

reviews charts for appropriate medical record documentation and appropriate coding. Candidate assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS/STAR Measures. Acts as a resource for the market on HEDIS measures, appropriate medical record documentation and appropriate coding. Candidate supports the development and implementation of quality improvement interventions and reviews in relation to plan providers.

• Advises and educates Provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.
• Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement.
• Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
• Delivers provider specific metrics and coach providers on gap closing opportunities.
• Develops, enhances and maintains provider clinical relationship across product lines.
• Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations.
• Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education.
• Provides resources and educational opportunities to provider and staff.
• Captures concerns/issues in action plans as agreed upon by Provider.
• Documents action plans and details of visits and outcomes; reports critical incidents and information regarding quality of care issues.
• Communicates with external data sources as needed to gather data necessary to measure identified outcomes.
• Provides communication such as newsletter articles, member education, outreach interventions and provider education.
• Coordinates and host clinic and event days to address provider/SDA missing services.
• Supports quality improvement program studies and HEDIS as needed, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Participates in and…