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HEDIS CLINICAL COORDINATOR

Company: River City Medical Group
Location: Sacramento
Posted on: June 14, 2018

Job Description:

Who We Are River City Medical Group (RCMG) is a progressive Independent Physician Association (IPA) of over 700 physicians uniquely dedicated to serving over 170,000 members within Sacramento's Medi-Cal population. Founded by longtime community physicians in 1992, it is our mission to not only understand the needs of our diverse communities, but to address them with creative and culturally sensitive health care solutions. RCMG serves as a supportive link between health plans, providers, and the members with a dedication to ensuring our entire health care delivery process operates smoother. With over 230 dedicated employees and growing, RCMG is an active member of the community helping to support it in our professional roles as an IPA. With the robust leadership of local practicing physicians, we are committed to ensuring our members and physicians are supported to provide the right care at the right time. A dedicated team implementing creative solutions to assist providers with focusing more on patient care and less on administration Community relations developing public and private partnerships that improve access to care and link members to services Doctors providing care to almost 1 in 2 Medi-Cal Beneficiaries in the Sacramento area Only IPA based in Sacramento County exclusively dedicated to serving the Medi-Cal population It is the policy of RCMG to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, RCMG will provide reasonable accommodations for qualified individuals with disabilities. Job Summary The HEDIS Clinical Coordinator will be responsible for coordinating, collaborating and completing HEDIS Department Quality Improvement activities that are consistent with company strategy, commitments, and goals. Responsibilities Audits and analyzes HEDIS provider data, developing recommendations for quality improvement activities for our providers and collaborating with RCMG management and other departments on these activities. Schedules and visits physician practices to implement HEDIS best practice solutions. Assists physician practices to identify opportunities to optimize HEDIS encounter data. Documents in appropriate systems and communicating with team members and management. Assists management in implementing key quality strategies. Works closely with affiliated entities on provider interventions, data collection and other quality-related projects. Audits and monitors internal department processes and materials for compliance with regulatory and accreditation standards related to HEDIS and assisting those departments on correcting any deficiencies. Communicates with internal departments, external companies and data sources as needed for data aggregation activities. Creates communications such as newsletters or provider education materials. Work with internal programs to run reports, summarize performance data, identify opportunities and relate information effectively to providers and management. Assists with HEDIS data evaluation and reporting to affiliated entities. Complete all company required trainings and external continuing education to keep licensure current. Performs related duties consistent with the scope and intent of the position. Regular attendance. Travel as required. Educational/License Requirements High School Diploma or GED required Current and Valid California License in the following disciplines is required: Licensed Vocational Nurse Current California Driver's License is required Qualifications and Experience 2 years of experience in a quality improvement required. 2 years of experience working as an LVN is required. 2 years HEDIS role preferred. 2 years of experience with medical coding/billing, specifically ICD-10 and CPT coding preferred. 2 years of any other combination of skills/experience related to HEDIS will be considered. Must have ability to accurately read, understand and interpret medical records. Proven ability to work autonomously and proactively implement quality improvement strategies. Strong understanding of HEDIS measures, coding, claims, billing and EHR systems. Strong computing proficiency, including reporting software, email and Microsoft Office. Ability to work as a cohesive team and collaborate with internal departments. Excellent communication, organization, and problem solving skills with attention to detail. Ability to enlist the support and actions of affiliated physicians to effectuate change, overcome barriers and convince others to implement known best practice solutions. Ability to demonstrate professionalism, integrity and strictly adhere to confidentiality standards set forth by the Health Insurance Privacy and Accountability act. Exceptional written and verbal communication, flexibility and time management skills. Ability to occasionally work outside normal business hours and travel locally. Ability to multitask and prioritize work load in a fast-paced environment with changing priorities and multiple deadlines. Effectively present HEDIS information in 1:1 or group settings and answer all related questions. Excellent active listening and critical thinking skills. Ability to solve mid-level problems with minimal supervision. Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers. Demonstrated excellence in project management and organization. Ability to provide and receive constructive job and/or industry related feedback. Ability to maintain confidentiality and appropriately share information on a need to know basis. Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information. Ability to consistently deliver excellent customer service. Excellent attention to detail and ability to document information accurately. Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives. Demonstrate commitment to the organization's mission. Must have mid-level skills in Microsoft software (Word, Excel, PowerPoint). Must have the ability to quickly learn and use new software tools. Must have mid-level skills using e-mail applications. Self-motivated with strong organizational, multi-tasking, planning, and follow up skills. Ability to work independently as well as in a team environment. Ability to present self in a professional manner and represent the Company image.

Keywords: River City Medical Group, Sacramento, HEDIS CLINICAL COORDINATOR, Healthcare, Sacramento, California

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