Remote Quality Improvement Data Coordinator - Medicare Advantage

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

As outlined below, provide quality improvement focused work for all delegated entities and support for ACO quality reporting for all contracted ACOs.

Work in a fully remote environment and virtually engage with company and team in your daily work. Subject Matter Expert (SME) on entire scope of Medicare Advantage STAR measures, services, customers and quality initiatives under various commercial and governmental payers. Conduct proactive patient outreach initiatives to identify and address quality gaps, engaging with patients to educate them on preventive care measures, schedule necessary screenings or appointments, and facilitate adherence to treatment plans and medications, thereby contributing to improved health outcomes and closing quality gaps Collect quality data using various methods of data sourcing-EMR, claims, provider / patient outreach. Manage daily work using multiple systems and applications-EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365 for Excel, Word and PowerPoint, Microsoft Outlook and Teams for messaging and meetings. Work with patient lists, gap lists, sourced health data and medical records in your daily work. Leverage all quality related resources to ensure accuracy and completeness of work-measure/project instructions, NCQA/HEDIS® specifications, coding documents, quick reference guides. Prioritize daily work to meet various quality reporting deadlines and requirements. Communicate quality performances, barriers and improvement strategies both internally and with customers. Follow all established policies and procedures for various QI workflows to ensure overall success. Collaborate w/ customers, payers, co-workers to accomplish daily work. Participate in all departmental and payer sponsored webinars/trainings/support calls throughout the year. Communicate professionally and develop positive relationships with co-workers, customers, providers and providers’ support staff.