Quality Audit Analyst BILHPN

Location: Westwood, MA
Job ID: 167406-1A
Date Posted: May 4, 2021
Category: Professional

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Job Description

Welcome To

Welcome to the Beth Israel Lahey Health Performance Network (BILHPN). BILHPN is a clinically integrated network of physicians, clinicians, and hospitals committed to providing high-quality, cost-effective care to the patients and communities they serve, while effectively managing medical expense. Leveraging best practices in population health management and data analytics, BILHPN improves care quality and patient health outcomes across Beth Israel Lahey Health through population health initiatives. BILHPN brings together the expertise of more than 4,500 providers across Eastern Massachusetts who share a common goal to achieve success in a value-based delivery system. 

About the Job

Reporting to the Manager of Quality, the Quality Audit Analyst works with various electronic health record and quality reporting systems to collect information from patient records and investigate discrepancies between medical record documentation and data reporting systems in support of BILHPN's quality and clinical programs and contractual obligations. The analyst is responsible for overseeing processes which assure the quality and integrity of data reported to various health plans and other stakeholders. This position also serves as the primary resource for collecting clinical data not available in BILHPN reporting systems. The analyst will utilize strong knowledge of healthcare quality measurement criteria and EHR systems to ensure the accuracy and completeness of quality measure submissions.

The Quality Audit Analyst’s Responsibilities are:

  1. Serves as a central resource to the BILHPN Quality department in the collection and submission of quality data to health plans through coordinating data collection with various physician practices and hospitals and locating data in electronic health records.
  1. Uses knowledge of electronic health records and quality measurement (HEDIS, AHRQ or Medicare Share Savings Quality Measures) to quality check that data submitted to payers is accurate and complete.
  1. Interprets population health level reports to identify care gaps and missing data.
  1. Implements various appeals processes.
  1. Understands and can clearly communicate, both verbally and in writing, clinical quality measure components of global payment contracts and EHR Use Requirements and can develop tools in support of collecting data that meets those requirements. Keeps current on quality measure specifications and communicates variations as appropriate.
  1. Documents project status, process workflows and technical details of all payor quality audits.

 

Qualifications:

  • Bachelor’s degree or 3-5 years related experience required in healthcare and familiarity with standard quality measures.
  • Strong knowledge and experience with HEDIS ambulatory quality measures required.
  • Ability to travel locally throughout Massachusetts and Southern New Hampshire.
  • Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint, and other web-based applications. May produce complex documents, perform analysis, and maintain databases.
  • Knowledge of electronic medical record, including eClinical Works, Athena, GE Centricity, and/or Epic

Scheduled Hours

Full time, 40 hours (Mon-Fri)

About Us

Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.