Quality Improvement Coordinator - #255255

Overview

Position Highlights:

• Full-Time, 40 hours per week
• Monday - Friday
• Primary Location: Downers Grove, IL.
  
  

Benefits:

• Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.
• Employer provided life and disability insurance.
• $5,250 Tuition Reimbursement per year.
• Immediate 401(k) match.
• 40 hours paid volunteer time off.
• A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.
• Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.
  
  

Responsibilities

The Coordinator of Quality Improvement reporting to the Manager of Quality Improvement coordinates all mandatory QI between carriers and Boncura Clients. The goal of the position is to help clients achieve maximum quality incentive through gaps in care reporting and sharing of best practices as well as ensures required reporting is completed on a timely basis. This person will also serve as a key liaison between the quality nurse and the reporting teams to ensure accurate and actionable reports are provided.

• Project manages submission of QI project documentation including but not limited to GPRO, 5 Star and HEDIS to appropriate carriers (50%)
• Coordinates reporting requests between nurse/specialist and reporting team
• Creates (run) monthly reports on gaps in care and generic utilization for distribution to all clients
• Confirms accuracy of quality data through detailed quality checks and internal audits
• To maximize Quality results, provide prospective outreach to patients anticipated to be in projects the following year
• Gathers information for payer quality audits documentation requests
• Create executive level summary of progress on QI projects for nurse/specialist to present to client medical director (15%)
• Performs data entry, as needed, for the submission of quality data related to the goals established by health plans (10%)
• Gather, confirm, track and resolve customer complaints as appropriate (5%)
• Monitor health plan portals for release of reports and notifications including but not limited final project lists, provider instructions. Share findings with team. (5%)
• Evaluates and disseminates changes to the BCBS MSA plan. Quantifying annual expected impact of changes to incentive compensation and ensuring necessary changes are made to maximize incentives earned. ( 5 %)
• Reviews NCQA, AGDIS and 5 Star for updates and makes recommendations to quality metrics and Epic documentation to ensure our compliance. Updates quick book reference guides for distribution to clients about measure guideline changes. (5% )
• All other duties as assigned (5%)
  
  

Qualifications

MINIMUM EDUCATION AND EXPERIENCE REQUIRED:

• High School Diploma Required
• 5 years healthcare experience.
  
  

Minimum Knowledge, Skills, And Abilities (ksa)

• Must have excellent communication, organizational skills and detail oriented.
• Computer proficiency in Microsoft Office, including ability to manipulate and sort data, write formulas, create graphs and tables, organize and structure data, and use pivot tables
• Ability to prioritize, organize, and multi-task work
• Work is not completely standardized. Assignments are usually received in the form of results expected, due dates, and general procedures to follow.
• Epic knowledge of format and content
• Ability to perform job functions and make independent decision as appropriate
  
  

The compensation for this role includes a base pay range of $20.59-30.89, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.