Quality Assurance Improvement Specialist
2 weeks ago
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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