Quality Assurance Improvement Specialist

2 weeks ago


Orlando, Florida, United States Palm Medical Centers Full time
Job Overview

Department: Quality Assurance

Reports to: Quality Manager

FLSA Status: Exempt

The Quality Improvement Coordinator plays a vital role in overseeing and evaluating medical record documentation, coding accuracy, and quality measures to ensure compliance. A comprehensive understanding of 5 STAR, PQRS, HEDIS, and CMS coding guidelines is essential for success in this position.

This specialist utilizes their expertise in ICD-9/ICD-10, CPT codes, and billing standards to assist in various audits and billing functions as determined by the Compliance, Operations, and Quality departments. The role also involves active participation in organization-wide quality initiatives.

Key Responsibilities:

  • Support quality assessment and performance enhancement activities, including monitoring and facilitating improvement projects.
  • Adhere to the latest documentation and coding standards.
  • Utilize only approved source documents for validation in support of quality measures.
  • Collaborate with primary care provider offices to gather data for quality measures initiatives.
  • Manage Gap reports for 5 STAR and assist with ACO GPRO quality measures projects as necessary.
  • Handle member and provider communications relevant to each project.
  • Educate office staff and providers on proper documentation and coding practices.
  • Report issues to Quality, Compliance, and Operations as needed.
  • Respond to inquiries related to quality improvement expertise.
  • Accurately enter validated measures into the electronic medical record (EMR) system.
  • Assist with RAPS submission projects as required.
  • Prepare quality and safety data reports for committees and meetings.
  • Create meeting materials and document quality improvement minutes when necessary.
  • Perform additional coding and documentation reviews or projects as assigned.

Required Skills and Qualifications:

  • Strong verbal and written communication abilities.
  • Exceptional organizational skills and attention to detail.
  • Proficient time management skills with a proven ability to meet deadlines.
  • Proficient in Microsoft Office Suite (Word and Excel) or similar software.
  • Ability to effectively share relevant information.
  • Strong critical thinking and problem-solving skills.
  • Experience with electronic health record (EHR) systems.
  • Willingness to travel as needed.
  • Ability to read and analyze medical records.
  • Knowledge of ICD-9/ICD-10, CPT codes, and quality improvement measures; CPC or CSSP certification is a plus.
  • Understanding of documentation, coding, and billing guidelines, as well as technical specifications for quality initiatives.

Education and Experience:

Preferred candidates will have a background in medical records or quality assurance, along with current ICD-9/ICD-10 coding education. A minimum of 1-2 years of experience in documentation or medical records within the healthcare continuum is required. Proficiency in Excel and Word will be assessed during the interview process.

Physical Requirements:

  • Prolonged periods of sitting at a desk and working on a computer.
  • Regularly required to sit, use hands and arms, talk, and hear.

Job Type: Full-time

Salary: $40,000 - $50,000 per year

Benefits:

  • 401(k)
  • Dental insurance
  • Employee assistance program
  • Flexible spending account
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8-hour shift
  • Day shift
  • Monday to Friday
  • On-call availability
  • Weekend availability


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