Ambulatory Quality Improvement Specialist

DUTIES:

Performs quality functions in support of the ambulatory division. Accurately updates patient information in the electronic medical record related to physician assignment deceased records multiple missed appointments and health plan disenrollment related to the daily operations of the practices. Reconciles and captures clinical quality documentation. Assists with health plan medical record review (MRR) surveys and compiles data for quality measure/health plan reporting. Assists with managing the data and clinical quality integrity of the medical record. Collaborates with the Manager to enhance quality measure provider and staff training clinical performance and process improvement efforts

SKILLS:

1. Supports quality operations of the Ambulatory Division providers and clinical staff.

2. Processes quality and clinical results data for medical records pertaining to care gap closures preventive chronic conditions and continuity of care.

3. Processes medical records and supplemental data and corresponding results in accordance with medical record policies for medical records received from outside facilities thirdparty vendors lab results and other external clinical data (i.e. updating health maintenance preventive and chronic condition care gaps lab and procedure results).

4. Utilizes clinical knowledge to review provider and staff documentation and updates medical record data received to ensure compliance with HEDIS and CMS measures through identified through health plan care gap lists.

5. Utilizes clinical knowledge of vaccinations and immunization schedules updates the medical record immunization profiles and California Immunization Registry (CAIR) to accurately reflect immunization compliance.

6. Use clinical knowledge and judgment to assess external medical data received for appropriate inclusion in the medical record and supplemental data to health plans.

7. Assists managers in identifying addressing and resolving patient medical record care gaps and issues; provides corrective feedback to team members when appropriate.

8. Utilizes clinical knowledge to perform medical record and immunization review/ audits in compliance with CDPH CHDP and HEDIS reporting requests and requirements.

9. Assists in patient outreach and identifying and resolving care gap closure lists in the medical records.

10. Performs duties related to policies associated with multiple missed appointments and disenrollment from the ambulatory departments.

11. Complies with NorthBays policies and procedures HIPAA safety and other applicable regulatory statutes.

12. Participates in process management activities and implements action plans.

13. Performs all other duties as assigned.

EDUCATION:

1. Education: AA degree is preferred. Graduate of an accredited Medical Assistant program required. Must have successfully completed the NorthBay Healthcare Medication Administration competency credential.

2. Licensure/Certification: Certified Medical Assistant required.

3. Experience: Minimum 3 years of experience working in a medical office in an outpatient setting.

4. Skills: Excellent oral and written communication skills and comprehensive knowledge of state and federal chart completion and release of information requirements. Knowledge of and experience with computers and computer systems. Ability to manage multiple tasks at one time. Demonstrated ability to lead others in complying with policies and procedures. Working knowledge of MS Word and MS Excel. Past experience with electronic medical records (i.e. Cerner applications or equivalent systems) required.

5. Interpersonal Skills: Demonstrates the NorthBay Way. The NorthBay Way is a set of valuebased behaviors that are to be consistently demonstrated and role modeled by all employees who work at NorthBay Healthcare. The NorthBay Way principles consist of Caring Communication Collaboration and Competence. Ability to work as a team member with providers staff and patients. Ability to complete assigned duties in a timely manner and prioritize workflow to meet deadlines. Ability to multitask and work on special projects. Capable of mature and independent judgment. Demonstrated leadership skills and creativity in problem solving. Flexibility and tact. Excellent communication skills and teamwork.

6. Standards of Performance: Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

7. Physical Effort: Attendance is an essential function of the job. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.