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Quality Assurance Specialist
2 months ago
InnovaCare Health is a forward-thinking, physician-led healthcare organization that is at the forefront of transforming value-based healthcare.
With over 40 clinics and a dedicated team of more than 1,100 employees, we are united by a shared mission, vision, and values that contribute to the success of the communities we serve.
Our commitment extends beyond healthcare; we prioritize work-life balance and support the personal and professional aspirations of our employees, enabling them to lead fulfilling lives.
We celebrate diversity and inclusion as core strengths of our organization.
Our impact in the community is reflected through public health education, outreach initiatives, and philanthropic efforts that reach beyond our facilities.
As we expand, we seek individuals who are passionate about enhancing the lives of those they serve each day.
Women's Health, Wellness, X-Ray/Ultrasound, Dental, Chiropractic, Urgent Care, Managed Care, and Workers Comp services.
Position Overview
The primary responsibilities of a Quality Assurance Specialist involve providing quality support to the clinic team and patients, ensuring that medical records are consistently updated, and that the clinic adheres to regulatory and quality record standards while addressing any issues or discrepancies that may arise.
In this capacity, the specialist will conduct audits on all medical records and analyze the data to confirm accuracy and assess the quality of patient care.
A comprehensive understanding of the CMS stars rating process, Medicaid Quality measures programs, and clinical standards and outcomes is essential for this role.
Key Responsibilities- Conduct daily reviews and prepare for the upcoming day's assigned provider's Cap patients.
- Review quality in medical records daily, updating them as necessary to facilitate preparation for the next day's patient visits.
- Coordinate care regarding quality gap measures with office managers and the Quality Improvement (QI) director.
- Manage quality gap measures events in collaboration with the QI director.
- Oversee quality chart review requests from insurance companies, documenting and following up as needed.
- Collaborate with clinic administrators to obtain medical records from hospitals, specialist visits, and/or SNH for follow-up on missing information.
- Identify and address errors related to billing or medical assistant documentation concerning quality measures.
- Timely submission of reports or spreadsheets to the QI Director for processing.
- Maintain the EHR/EMR system (e.g., eCW, NextGen) by:
- Identifying and correcting any patient information errors.
- Updating quality spreadsheets.
- Managing CDSS/Alerts.
- Overseeing Quality Global Alerts.
- Utilizing the Arcadia Quality Measures Portal.
Minimum Qualifications
- Completion of at least a two-year associate degree from a technical school or community college.
- Medical Assistant certification is required.
- Two years of experience with EHR/EMR systems (eCW, NextGen, or similar preferred).
- 1-2 years of healthcare experience, preferably as a quality coordinator.
- One year of experience with Stars Rating/Medicaid quality measures.
Preferred Qualifications
- Strong relationship management skills.
- Effective written and verbal communication abilities.
- Capability to advocate for change.
- Proficient in performing critical clinical analysis.
- Ability to plan and organize reports effectively.
Physical & Mental Requirements:
- Required immunizations and vaccinations.
- Ability to lift up to 50 pounds.
- Ability to push or pull heavy objects using up to 100 pounds of force.
- Ability to stand or sit for extended periods.
- Ability to use fine motor skills for operating equipment and/or machinery.
- Ability to properly drive and operate a company vehicle.
- Ability to comprehend instructions both verbally and in writing.
- Ability to use logical reasoning for problem-solving.
- Occasional exposure to communicable diseases or bodily fluids.
- Ability to distinguish shades of color when reading a dipstick.
The information provided above is not exhaustive of all duties and responsibilities performed. This job description does not constitute an employment agreement or contract. Management reserves the right to modify this job description at any time without notice.