Teams at GlobalHealth Holdings, LLC

Supports Medicare medication adherence and quality initiatives by conducting member and provider outreach, educating members on compliance, tracking calls and statuses, entering data, reviewing prescription records, and monitoring CMS STARS measures. Maintains confidentiality of protected health information under HIPAA and works in a sedentary clerical office environment with no travel or supervisory responsibilities.

Supports healthcare quality initiatives by managing care gaps, conducting member and provider outreach, educating providers on quality measures, entering data, reviewing medical records, tracking referrals, documenting coding, and auditing provider records. Requires knowledge of HEDIS, CAHPS, HOS, Meaningful Use, CMS standards, HIPAA, and electronic health records. The role requires extensive travel during audit season and occasional overnight stays.

Supervises Clinical Quality Specialists and oversees HEDIS-related quality initiatives, provider/member outreach, record audits, data entry, and medical record review to ensure compliance with CMS measures. Maintains PHI confidentiality and coordinates substantial travel for on-site audits.