Clinical Quality Reporting Specialist - Entry Level

Job Summary:

Working under the supervision of the Director of Quality and in collaboration with the Quality Support and Reporting Team, the entry level Clinical Quality Reporting Specialist is responsible for collecting, analyzing, and reporting clinical data to support quality improvement initiatives in the primary care setting. This role works closely with the Lead Clinical Quality Reporting Specialist and the Director of Quality to support efforts to ensure compliance with regulatory and payer requirements, and to drive improvements in patient outcomes and care delivery. Reviews and maintains abstracted records, quality assurance and data entry. Facilitates communication between providers and health plans to optimize health and wellness, reduce inpatient admission, reduce re-admissions, and improve medical stability in the patient population served. Contributes to the coordination of HEDIS data collection and transmission.

Communication:

Good oral and written communication skills are required for this position. Information must be exchanged using tact and persuasion appropriately. The person in this position must be able to communicate with patients, staff, and others; and contribute to a positive and motivating environment.

Key Responsibilities: 

• Collect, validate, and analyze clinical quality data from Electronic Health Records (EHR) and other reporting systems.
• Maintain routine reports related to quality including HEDIS, UDS, and value-based care metrics.
• Identify trends, gaps, and opportunities for improvement in patient care quality and outcomes.
• Support the implementation and monitoring of quality improvement initiatives, including grant funded projects.
• Support timely and accurate submission of data to payers, government agencies, and accrediting organizations through PI initiatives and work directly with heath plan portals and virtual databases.
• Develop a strong knowledge base related to industry standards, regulatory changes, and payer requirements for quality reporting.
• Attends insurance representative meetings, QI initiative meetings, and educational sessions. 
• Performs all other related duties as assigned.

Qualifications:

• Subject matter expertise related to HEDIS, UDS, CMS MIPS, and value-based care metrics strongly preferred. Interest in continued development in this area is required.
• 1 years of experience in healthcare data analysis or quality reporting, preferably in a primary care or outpatient setting (or a role with transferable skills and knowledge base) preferred.
• Familiarity with EHR systems (e.g., Epic, eClinicalWorks, NextGen). Proficient use of Athena EHR is strongly preferred.
• Strong analytical and problem-solving skills.
• Competent to Proficient use of Microsoft suite of products; Excel, Outlook, Word, PowerPoint.
• Excellent communication and teamwork skills.
• Excellent phone communication skills and focus on patient experience.
• Strong self-motivation, organizational skills, and dependability.
• Ability to multitask, set goals, monitor progress, and receive feedback.

Licenses & Certifications:

• High School Diploma or GED required.
• MA or CNA current licensure a plus
• Current CPR certification preferred

 Physical Requirements

• Level 2 background clearance required
• Proof of immunizations for (1) Tdap, (2) MMR’s, HEP B vaccination, and either a history of chicken pox (varicella), or documentation of the varicella vaccine, a PPD Test is done once upon hire

WFHC reserves the right to change or modify the job description, including but not limited to Major Responsibilities, Education, Certification, and Physical Requirements. 

WFHC is an EOE.