The Clinical Quality Data and Reporting Analyst serves as a liaison between the Emory Healthcare Network (EHN) Clinically Integrated Network and participating physician practices to support accurate, timely, and complete clinical quality reporting across multiple programs including Medicare CQMs, HEDIS, Stars, and Commercial payer quality initiatives. This role is responsible for educating and guiding practices in appropriate clinical documentation, optimizing EMR data capture, enabling CPT II coding, and supporting the generation and submission of QRDA/CCDA reports and supplemental data files for gap closure.
RESPONSIBILITIES:
Quality Reporting & Data Submission:
- Collaborates with EHN-affiliated practices to ensure accurate documentation in structured data fields within their EMRs to meet Medicare and Commercial payer quality reporting requirements.
- Facilitates the generation, review, and validation of QRDA Category I and III and CCDA reports to support clinical quality measure (CQM) submissions.
- Supports the identification, extraction, and submission of supplemental data files for gap closure, particularly for Medicare Advantage and Commercial health plans.
- Supports the Emory quality team in preparing accurate, granular data for the quality portion of payer committee meetings.
Coding & Workflow Integration:
- Provides guidance to practices on appropriate CPT II coding setup and workflow integration to support real-time quality reporting.
- Assists practices with EMR optimization efforts to align clinical workflows with quality data capture and billing requirements.
EMR Data Management & Integrity:
- Serves as the subject matter expert (SME) for quality data capture and extraction across varied EMR platforms (e.g., Epic, Athenahealth, eClinicalWorks, Allscripts, NextGen, Greenway, etc.).
- Works closely with EMR vendor support teams, CIN IT/data teams, and practice personnel to troubleshoot data integrity, mapping, and reporting issues.
Performance Monitoring & Improvement:
- Monitors practice-level quality performance, provides ongoing feedback, and supports remediation planning.
Regulatory Compliance & Program Knowledge:
- Stays current with CMS regulations, HEDIS/Stars requirements, and payer-specific quality programs and reporting mechanisms.
Training & Education:
- Contributes to the development of training materials and delivers educational sessions to practices on quality documentation best practices.
Additional Duties as Assigned Travel:
- Estimated travel requirement 25-50%, with ability to travel to EHN physician practice locations.
Work Type:
- Hybrid employee - splits time working remotely, in the office, and EHN providers at their place of practice.
Minimum Required Qualifications:
Education:
- Bachelor's degree in Health Information Management, Nursing, Public Health, Healthcare Administration, or a related field.
Experience:
- Minimum 3 years of experience in clinical quality reporting or population health analytics, preferably within a CIN, ACO, or health system setting.
Knowledge, skills, and abilities (required):
- Strong working knowledge of HEDIS, CMS Quality Payment Program (QPP), Medicare CQMs, Stars measures, and CPT II coding.
- Expertise with EMR platforms, including configuration and data extraction/reporting capabilities. Experience with QRDA and CCDA file formats is required.
- Demonstrated experience working with supplemental data submissions to Medicare Advantage and Commercial payers.
- Familiarity with NCQA, CMS, and payer-specific quality reporting rules and technical specifications.
- Excellent interpersonal communication and training skills with the ability to engage clinicians, staff, and vendor partners.
- Detail-oriented with strong problem-solving and analytical skills.
- Proficiency in Excel, health data platforms, and familiarity with data query tools.
Preferred Qualifications Education:
- IN Health Information Management, Nursing, Public Health, Healthcare Administration, or a related field.
- Knowledge, skills, and ability requirements (preferred): Proficiency in SQL, preferred.