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St. Mary’s Healthcare has been providing high-quality, compassionate healthcare to the people of Montgomery and Fulton counties since 1903. At St. Mary’s Hospital, the Rao Outpatient Pavilion and other locations, the local, independent healthcare organization offers the comprehensive, critical services its community needs and deserves. St. Mary’s Healthcare has also been named a 2025 Times Union Top Workplace—the first acute care hospital in the Capital Region to earn the distinction since the Times Union launched the recognition program 14 years ago.

Job Requisition: REQ 4095

Employment Type: Full- Time

Shift: Days

Hours Per Week: 40 hours

Hiring Range:$17.00- $22.74 hourly

The actual compensation for this position will be determined based on experience and other factors permitted by law.

Responsibilities:

+ Support quality improvement and performance initiatives across primary care practices.

+ Review, reconcile, and maintain payer quality and suspect condition reports.

+ Document quality gaps in patient charts and upload supporting information to payer platforms.

+ Assist with payer file submissions and validation of supplemental data to ensure accurate reconciliation of closed gaps and quality metrics.

+ Validate and analyze data from internal reports and supplemental files to ensure accuracy.

+ Assist with patient outreach and scheduling for preventive and chronic care needs.

+ Partner with providers, care teams, and staff to align documentation with quality measures.

+ Coordinate with payer representatives to verify data, resolve discrepancies, and monitor progress.

+ Identify trends and opportunities for workflow or documentation improvement.

+ Support the Supervisor of Clinical Improvement with projects related to NCQA, 1115 Waiver, and other internal organizational or external programs.

Additional Responsibilities:

+ Other duties as assigned

Education, Training & Experience:

+ High school diploma/GED required. Associate degree in healthcare, business, or related field strongly preferred.

+ Minimum of one (1) year experience in a medical office, healthcare quality, or population health setting required. Minimum of one (1) year experience working with electronic health records and understanding office workflows, scheduling templates, and patient processes required.

+ Knowledge of HEDIS measures, population health concepts, quality reporting programs, PCMH and NCQA standards preferred. Candidate must be comfortable navigating multiple EHRs, payer portals, and technology platforms; demonstrates adaptability and a willingness to learn new systems quickly.

Required Skills and Attributes:

+ Ability to organize and establish day-to-day priorities while using critical thinking skills in all aspects of the job.

+ Must be able to multitask while remaining professional, focused, composed and positive.

+ Excellent customer service skills

+ Displays integrity, friendliness, and compassion.

+ Must be able to establish an appropriate and effective rapport with others.

+ Demonstrates flexibility

+ Takes initiative

+ Able to work in a fast-paced environment

+ Embraces new opportunities to grow both personally and professionally.

+ Effective critical thinking and problem-solving skills.

+ Proficient with various Microsoft Office products (Word and Excel).

+ Strong organizational skills.

+ Effective interpersonal skills.

+ Ability to take and follow direction in a positive and appropriate manner.

+ Ability to work as part of a team and independently. Must be able to demonstrate effective and appropriate written and oral communication skills.

+ Must be able to speak, read, write and follow instructions in English .