Healthcare Quality Specialist
15 days ago
West Palm Beach
Job Description Job Title: ACO Quality Specialist Department: Quality Reports To: VP of Performance Improvement FLSA Status: Exempt About Us: We are one of the top accountable care organizations (ACO) in the United States. Our company produces and manages proprietary applications, including multiple physician-facing mobile and web apps designed to enhance care coordination for our ACO participants. We are dedicated to driving innovation and excellence in value-based care. Position Summary: The ACO Quality Specialist plays a hands-on role in supporting the design, implementation, and daily management of quality programs across Medicare Shared Savings Program (MSSP), ACO REACH, and Commercial payer arrangements. This position is responsible for accurate quality reporting, gaps-in-care closure, CAHPS survey support, and health equity planning while ensuring compliance with CMS and payer requirements. The role requires strong data management, provider support, and direct coordination with practices and consultants to drive measurable improvements in patient quality outcomes and contractual performance. Key Responsibilities: Quality Program Execution & Reporting • Manage the day-to-day quality reporting process for assigned payer programs, ensuring accurate and timely data submission., • Manage the creation, distribution, and tracking of Gaps in Care reports across assigned payer programs to support proactive quality measure closure., • Prepare and manage clinical quality measure readiness efforts in collaboration with internal analysts and technical teams, ensuring EHR alignment and measure mapping accuracy., • Facilitate the collection, review, and submission of quality attestations, providing practices with training and documentation support., • Support patient experience survey readiness (CAHPS), including provider and patient education to improve response rates., • Participate in payer audits, providing documentation and subject matter expertise on numerator compliance, exclusions, and program requirements., • Collect, validate, and analyze clinical and operational data to identify opportunities for performance and quality improvement., • Conduct claims research and audit medical records to demonstrate performance against payer contract metrics., • Monitor payer-specific requirements (e.g., MSSP CQM, ACO REACH HEDR adjustments, Health Equity Plan deliverables) and track readiness to ensure compliance., • Provide practice transformation support to primary care practitioners to promote more integrated, advanced care models., • Collaborate with consultants and practice staff to close gaps in care, improve workflows, and maximize outcomes on quality programs., • Develop and facilitate training for internal staff, provider networks, and consultants on quality programs, documentation requirements, and care gap closure strategies., • Provide expertise and support on quality measure requirements for MSSP, ACO REACH, Commercial programs, and regulatory frameworks such as MIPS, HEDIS, CQMs, and STARS., • Train providers and staff on effective use of EHRs and related clinical/technical systems for accurate data capture and reporting., • Ensure compliance with CMS regulations, accreditation bodies (e.g., NCQA), payer requirements, and ACO program standards., • Participate in Quality and Performance Committee meetings, contributing to documentation, tracking, and reporting of initiatives. Key Performance Indicators (KPIs): Quality Performance & Reporting • 100% of quality data submissions (MSSP, ACO REACH, Commercial) completed accurately and on time., • Meet predesignated attestation collection goals on a weekly and monthly basis., • ≥60% of identified gaps in care closed prior to reporting deadlines., • 100% successful completion of payer and regulatory audits with no major deficiencies., • 100% of practices receive yearly performance feedback reports., • ≥80% of performance improvement projects achieve defined goals and timelines., • ≥75% of recommended operational improvements implemented that result in measurable efficiency or quality gains., • 100% participation in Quality and Performance Committee meetings, with proper documentation of initiatives. Qualifications: Education & Experience: • Bachelor’s degree in nursing, Public Health, Healthcare Administration, or related field required; Master’s degree preferred., • Minimum 3–5 years of experience in healthcare quality or performance improvement, preferably in an ACO or value-based care setting., • Experience with quality measurement programs such as CMS ACO measures, HEDIS, STARS, and CAHPS required., • Experience conducting data analysis and using QI methodologies (Lean, Six Sigma, PDSA, etc.). Licensure/Certifications: • Certified Professional in Healthcare Quality (CPHQ) or equivalent preferred., • Clinical licensure (e.g., RN, LPN) a plus but not required. Knowledge, Skills, and Abilities: • Knowledge of quality improvement theory, strategy, and practical methods to achieve rapid cycle improvement., • Familiarity with regulatory requirements and accreditation standards in healthcare (e.g. HEDIS)., • Experience with electronic health record (EHR) systems and healthcare data analytics tools is a plus., • Ability to establish and maintain positive professional working relationships within and outside organization., • Outstanding interpersonal, service excellence behavior and customer service skills required., • Effective oral and written communication and presentation skills., • Must be a team player and contribute to building a strong team dynamic., • Ability to perform effectively under pressure, maintain focus on responsibilities, and manage competing priorities., • Ability to evaluate data, establish facts, and draw valid conclusions., • Ability to draft reports (committee memos, clinical investigations)., • Must be self-motivated, organized, and detail oriented., • Adheres to HIPAA requirements and maintains confidentiality of all data., • Highly proficient in using Excel, Word, and Power Point In a business setting.