As the Clinical Quality Measure Developer at AIR and Research Associate at IMPAQ International, I develop and maintain provider-level and hospital-level electronic clinical quality measures (eCQMs), including eCQM hybrid measures, which merge electronic health record (EHR) data elements with claims data to calculate measure results. This role requires expertise in developing measures using eCQM standards and authoring languages such as the Centers for Medicare and Medicaid Services’ (CMS) Quality Data Model (QDM), and Health Level Seven International’s (HL7) Clinical Quality Language (CQL) and Fast Healthcare Interoperability Resources (FHIR). The position requires an understanding of CMS quality reporting systems and data submission requirements. The role also includes participation in information gathering, literature reviews and data analysis, synthesis of input from technical advisory and expert panels and public comments.

Here, I strategized, planned and executed clinical analytical projects in alignment with product and clinical content standards. I gathered and analyzed business requirements for net new development and improvements to business rules and content with emphasis on Clinical Quality Measures (CQMs). With an understanding of FHIR-defined terminology and ontology standards, I aided the clinical content development process. I also created measure development artifacts of clinical code systems including ICD10, ICD9, SNOMEDCT, CPT, RxNorm, LOINC, and CVX. Additionally, I demonstrated knowledge of clinical quality regulatory reporting requirements for various programs including Merit-Based Incentive Payment System (MIPS), Medicare Shared Savings Program (MSSP), and HEDIS®. I also developed and validated measures using tools including Value Set Authority Center (VSAC), Bonnie, Measure Authoring Tool (MAT), and JSON files.Some of my key contributions are as follows:■Continuously completed projects on time and in alignment with predefined expectations by collaborating with and leading teams, gathering requirements, coordinating tasks, monitoring progress, and resolving issues in early phases.■Translated approximately 100 CQMs logic to HL7’s Clinical Quality Language (CQL) for consumption and interpretation by measure engine in under 1.5 years, surpassing internal and external customer timeline expectations. ■Boosted team performance by creating multiple user guides and training documentation for clinical processes and tools, decreasing onboarding time by 25%; personally trained up to 25 staff members.■Showcased high-level analytical skills to identify over 90% of approved business requirements for net new development and enhancements to existing clinical rules and content.

Applying clinical expertise, I drove the successful development and deployment of cloud-based clinical products and the expansion of a centralized clinical quality measure service. I defined standard practices and provided insight across clinical content, measure development, clinical codes, rule specifications, and regulatory requirements. Some of my key contributions are as follows:■Led product development lifecycle and an agile development team of 10 engineers, clinicians, and testers to create, deploy, maintain, and improve EHR reporting systems including Quality eMeasures for Professionals™ (QeMP) and Quality eMeasures for Hospitals™ (QeMH).■Aided 100% of customers in meeting regulatory program requirements such as PQRS and CMS’ EHR Incentive Program annually by providing QeMP and QeMH support.■Received executive-level praise for subject matter expertise in clinical content and terminology standards, measure development, rule specifications, and regulatory quality of care reporting requirements.

In this role, I developed product modules for clinical intelligence and decision support and guided a team of 15 individuals while steering the design, development, quality assurance, and deployment of clinical and analytical content for a suite of care management products and services. Additionally, I headed clinical and operational aspects of the InterQual® quarterly and annual releases. Some of my key contributions are as follows:■Improved HEDIS software certification process by participating in NCQA’s Coding Committee and extending a beta partnership with them, leading to achievement of full certification of HEDIS reporting software ahead of schedule year over year. ■Reduced process time for enhancing clinical content within products by 50% by creating a standard diagnosis, procedure, and drug code update process, leading to improved customer satisfaction.■Streamlined operations in clinical development department by creating and maintaining terminologies, mappings, and code sets for an entire suite of clinical decision support and quality reporting products.