Quality Performance Reviewer

Quality Performance ReviewerFounded in 1970, East Valley Community Health Center is a Federally Qualified Health Center (FQHC) whose services include providing personalized, affordable, high-quality medical, dental, vision, and behavioral health care through a community-based network within the East San Gabriel Valley and Pomona Communities. Our staff practices patient-centered care by serving each patient with a personalized care plan that meets their individual needs. Our patients have access to support services that include nutrition, health education, case management, pharmacy, lab, and x-ray at our health center locations. East Valley serves the health care needs of uninsured and underserved individuals and families throughout our 8 health center locations.Our mission is to provide access to excellent health care while engaging and empowering our patients, employees, and partners to improve their well-being and the health of our communities.The Quality Performance Reviewer is responsible for conducting daily review of medical charts to monitor and evaluate all relevant core processes and quality measures for compliance in accordance with federal, state, and health plans guidelines. This will include HEDIS and Medicare Advantage Star measure specifications.

The Reviewer will ensure that workflow practices meet the professional standards of East Valley through the review of clinical documentation for completeness, accuracy, and compliance. The Reviewer will complete reviews within established timeframe and provide education to clinician and staff for documentation and quality improvement. The Reviewer may assist in developing corrective action plans as needed. The position may require travel within the different clinic sites.Major Position Responsibilities and Functions:Conduct daily reviews of medical records to ensure all required elements are documented appropriatelyProvide feedback to providers and care team members of incomplete or inaccurate documentationContinuously monitor areas of deficiency are addressed appropriately and timely by providers and care team members to meet internal requirements and regulatory standardsProvide consistent and timely reporting of provider documentation issues to managementCollects and enters confidential information ensuring the highest level of confidentiality in all areasAssist in the development of provider clinical education tools using chart findings to improve accuracy in documentationAssist in conducting mock audits in preparation for regulatory and health plan auditsMaintain understanding and ability to interpret current regulatory agencies and health plans requirements related to medical recordAbility to use independent judgement related to medical record reviewOther duties as assignedPosition Requirements and Qualifications:Minimum 2 years' experience with medical record review working in a health care settingWorking knowledge of HEDIS and Medicare Advantage Star measuresExperience with EMR systems, preferably NextGenAbility to be assertive and tactful when communicating with medical staffKnowledge of all current Windows based programs.Ability to multi-task and prioritize daily workloadHigh level of verbal and written communicationEast Valley offers a competitive salary, excellent benefits to include: medical, dental, vision, and 403b retirement plan. We match the first 6% of employee contributions, and full vesting starts immediately.

You will also enjoy work-life balance with paid time off and paid holidays throughout the year.Please apply to this position with your current resume. Principals only. Recruiters, please do not contact this job posting. EOE is the Law. It is the stated policy of EVCHC to conform to all the laws, statutes, and regulations concerning equal employment opportunities and affirmative action.

We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, or national origin, age, disability status, Genetic Information & Testing, Family & Medical Leave, protected veteran status, or any other characteristic protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.