Quality Specialist, Gaps in Care - National Population Health

DetailsDepartment: Population Health OperationsSchedule: Monday-FridayLocation: RemoteSalary: $69,212-$101,223BenefitsPaid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your communityBenefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.ResponsibilitiesWe are seeking an exceptionally detail-oriented and quick-moving Quality Specialist to join our National Population Health team. This critical role is dedicated to maximizing our health system's performance in value-based care contracts by supporting the closure of care gaps and ensuring impeccable documentation for quality measure reporting.The specialist will operate with a focus highly similar to a HEDIS Auditor, performing extensive electronic medical record (EHR) review and data abstraction to validate compliance with quality metrics (e.g., HEDIS, eCQMs). This is an essential, high-volume, and fast-paced role that requires deep subject matter expertise in quality metrics, comfort with EHR systems (e.g., Epic, Cerner, Athena), and a strong commitment to team-based performance.Quality Measure Auditing & Documentation SupportServe as an in-house subject matter expert on ambulatory quality metrics tied to value-based contracts, with a deep, working knowledge of NCQA HEDIS measures.Perform high-volume, hands-on review and abstraction of clinical data from EHR systems (Epic, Cerner, Athena) to identify, validate, and document evidence that meets quality measure specifications.Assist in the execution of strategies to retrieve and analyze medical records to support quality measure documentation and reporting for payer audits and HEDIS reporting.Ensure that clinical documentation is accurate and complete to support payer audits and other contract-related requirements.Audit the organization's supplemental data files to payors and electronic clinical quality measure (eCQM) mapping from the EHR.Care Gap Closure & Performance Improvement SupportSupport the monitoring of performance and progress toward organizational quality measure goals.Assist in implementing system-wide workflows and interventions designed to close care gaps for preventive care, screenings, and chronic condition management.Contribute to the development and implementation of targeted outreach campaigns by providing data and documentation insights to address care gaps in high-priority populations.Participate in the development of education and training to support the organization's markets.Maintain credible documentation and assist with payor portal uploads as appropriate.Participate in day-to-day oversight and monitoring of contractual requirements related to government programs, including Medicare.Data Analysis & CollaborationAssist in translating complex quality data into meaningful reports or insights for clinical and operations teams to support performance improvement.Collaborate with the Manager, Gaps in Care, and internal departments (e.g., IT, Analytics) to ensure the timely and accurate ingestion and validation of quality-related payer data feeds.Work collaboratively with care teams and providers to address documentation best practices and the impact of their work on value-based care performance.Prepare summary reports with findings to share with market teams.Act as a team player with a collaborative attitude to deliver performance improvement activities.Expert working knowledge of quality measurement frameworks, specifically HEDIS and related specifications.Proven experience working with and navigating Electronic Health Record (EHR) systems (e.g., Epic, Cerner, Athena) for chart review and data extraction.Strong technical proficiency in using systems for performance reporting and data review.Exceptional attention to detail and organizational skills for high-volume, accurate data abstraction and documentation.Ability to work in a fast-paced, deadline-driven environment as part of a high-performing, team-oriented culture.Strong verbal and written communication skills to effectively collaborate with clinical and non-clinical staff.Support the research, design, and implementation of new and existing strategic solutions, capabilities and service offerings to drive program growth and profitability.Participate in day-to-day oversight and monitoring of regulatory and contractual requirements related to government programs including, but not limited to, Medicaid and Medicare.Assist in the monitoring of daily government program activities to ensure contractual compliance with regulatory agencies for business lines.Facilitate engagement with the SmartHealth administrative team.Analyze cost and utilization reports to deliver performance improvement activities leading to improved care destination choices and expedient access to care.Support collaboration with the Mission-Inspired Transformation team on innovations and operations designed to transform care and deliver on the organization's mission of reaching and serving the vulnerable.RequirementsEducation:High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree OR 4 years of applicable cumulative job specific experience required.Additional PreferencesClinical licensure (e.g., RN, LPN) or a background in Health Information Management (HIM) is a plus.Familiarity with data visualization tools such as Tableau or Power BI.Experience working within a health system, ACO, or integrated delivery network.3+ years of experience in healthcare quality, population health, or a payer-side HEDIS audit/abstraction role (preferred, minimum 2 years required).Demonstrated experience with the auditing/abstraction of clinical data points from medical records, with a strong focus on HEDIS measures.Experience with value-based care programs (e.g., Medicare Advantage, ACOs, Commercial risk) is strongly preferred.Why Join Our TeamAscension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters.Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.Equal Employment Opportunity EmployerAscension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws.For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.Pay Non-Discrimination NoticePlease note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.E-Verify StatementThis employer participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.E-Verify