Do you want to work for a company that has been recognized by the Denver Post for nearly a decade as a Top Place to Work? Then Physician Health Partners may be the company for you! PHP offers a robust benefit package where the company pays for a majority of medical premiums, vision insurance, dental insurance, 2-week paid FMLA, 401(k) matching, in addition to some perks like happy hours, remote work options and profit sharing! We have two locations in Downtown Denver and Colorado Springs but serve members throughout the state Colorado. If you are interested in working for an innovative and collaborative workplace in the healthcare market than PHP may be the career home for you.

This is a Work From Home role working 40 hours a week Monday - Friday

Position Summary: Responsible for conducting clinical quality audits for the Quality department. Audits include reviewing outpatient medical records, hospital records, clinical lab, and pharmacy records. Collects data using standardized methodologies and organizes the data to identify potential areas for quality improvement. Use EMR data to validate third-party data aggregation software. Outreaches to external partners to coordinate timely receipt of care for patients. Must be able to proficiently use multiple Electronic Medical Record (EMR) platforms to perform audits and accurately report results to internal and external teams using various web interfaces.

COMPETENCIES/Role-Specific Functions:

COMMUNICATION

Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

• Collaborate with Practice Transformation Coaches to develop meaningful practice-level reporting to assist practices in closing clinical quality measures more effectively.
• Work with Practice Transformation Coaches to supplement existing educational forums, explain reports and provide audit summaries upon each Practice Summit and Progress audit completion.
• Consistently communicate identified errors or obstacles to the proper parties.
• Able to communicate findings in a clear, concise manner, both internally and externally.
• Skilled in presenting and explaining data in a clear, concise manner.

PROBLEM SOLVING

Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.

• Assist in identifying potential data flow obstacles within assigned practices and work with staff to develop action plans to assist practices in overcoming barriers.
• Identify errors in the third-party data aggregation software and collaborate with Practice Transformation Coaches and Program Management to resolve them.
• Identify opportunities for improvement and share suggestions with leadership, coaching team, or practices.
• Assist with appeals research.
• Able to work with sensitive data and relay potential issues or concerns in a diplomatic manner.

PRODUCTIVITY

• Complete all data entry requirements in a timely manner
• Perform timely quality audits and attestation for internal quality programs or health plan partners.
• Assist with outreach to pharmacies and imaging centers for clinical quality measure closure.
• Skilled in responding to practice inquiries in a timely and accurate manner.
• Skilled in working collaboratively with various parties to develop an accurate and meaningful reporting package for practices.

SELF DEVELOPMENT

Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.

• Enhances professional growth by learning new skills and techniques that will enhance the PHP and CQIS programs and goals.

CUSTOMER FOCUS

Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

• Maintains excellent relationship with their assigned practice and ensures practice needs are met
• Able to work effectively with physicians, health plan personnel, and Revenue Coding staff.
• Able to work with external parties to incorporate data elements into reporting package.

JOB KNOWLEDGE

Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.

• Utilizes technical measure specifications from the relevant authorities (CMS, HEDIS, NCQA, etc) to audit medical records.
• Ability to learn and use new software and data tools (clinical quality data submission portals).
• Navigates an electronic medical record
• Understands diagnosis codes and CPT codes, medical terminology to audit medical record.

Qualifications (Education/Experience/Knowledge/Skills/Abilities):

• High School Diploma/GED required, Associates or Bachelors’ degree preferred.
• Medical Assistant, Medical Records, Referral Coordination or similar experience required. Certification in healthcare preferred.
• Minimum two years’ experience in a medical office, hospital or healthcare setting working with medical records and/or patients.
• Knowledge of medical terminology, diagnosis codes and CPT codes required
• Knowledge and comfort with at least one EHR or Electronic Health Record
• Knowledge of clinical quality and population health preferred.
• Comfort with and ability to learn and apply technical measure specifications from the relevant authorities (CMS, HEDIS, NCQA, etc.) preferred.
• Comfort and exposure to CQI (continuous quality improvement) principles and lean methodologies preferred.
• Knowledge of Excel preferred.
• Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.
• Mobile Device for work purposes as defined by the company policies and procedures.