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Quality Analyst

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Quality Analyst is responsible for assisting the practices / network in increasing quality and cost scores by closing care gaps via various platforms. This role works closely with our Lead Quality Analyst, Practice Liaisons and Quality Supervisor to effectively support Quality Enhancement / Incentive Programs, Pay for Performance and Shared Savings Programs. The goal is to improve the quality, efficiency, and overall value of care for our patients accurately while increasing revenue through achieving optimal outcomes based on payor specifications.

Job Duties and Responsibilities :

Essential Functions :

• Demonstrates proficiency in retrieving and entering data into clinical systems including EHR and various payer platforms.
• Addresses gaps in care identified by standard payer reports and practice generated in-basket message requests through the EHR system efficiently.
• Demonstrates proficiency in maintaining the health plans regulatory requirements for HEDIS, NCQA and CMS quality metrics / programs.
• Retrieves clinical documentation to complete care gap closure utilizing every resource available including patient and external facility outreach.
• Follows department / network protocols and complies to established deadlines.
• Submits collected data proactively throughout the year through various payor platforms.
• Develops a relationship with prospective and current practices as an extended member of the care team to work towards network goals.
• Aids in insurance patient attribution utilizing insurance driven patient lists and / or practice requests.
• Assists in monitoring and / or scheduling primary care visits when necessary.
• Exhibits understanding of practice workflows to optimally identify site-level opportunities and assists with suggestions for improvement of quality scores.
• Completes timely communication with patients post ED discharge through patient outreach derived from payer or network generated lists.
• Participates in chart audits when applicable and reviews completed audit findings with lead quality analyst and quality supervisor.
• Maintains confidentiality of all materials handled within the Network / Entity as well as the proper release of information.
• Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.
• Demonstrates / models the Network's Service Excellence Standards of Performance in interactions with all customers (internal and external).
• Demonstrates Performance Improvement in the following areas as appropriate : Clinical Care / Outcomes, Customer / Service Improvement, Operational System / Process, and Safety.
• Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes and practices.
• Complies with Network and departmental policies regarding attendance and dress code.
• Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated.