Job Description

Job description

Department: Quality Assurance

Reports to: Quality Manager

FLSA Status: Exempt

Overview

The role of the Quality Improvement- (QI Specialist) is to monitor and audit medical record documentation, coding and quality measures for compliance and accuracy. It is critical for the QI Specialist to have knowledge of 5 STAR, PQRS, HEDIS, CMS coding guidelines, and coding/documentation and billing standards and regulations.

The QI Specialist uses their knowledge of ICD-9/ICD-10, CPT, and documentation guidelines as well as billing knowledge to assist in any and all coding and documentation audits and/or billing functions as determined by the Compliance, Operations, and/or Quality department(s). Additionally, the QI Specialist participates in company-wide quality initiatives.

Key Duties & Responsibilities:

· Provides support for quality assessment and performance improvement activities that include quality monitoring, evaluation and facilitation of performance improvement projects.

· Follows most recent documentation and coding guidelines

· Uses only pre-approved source documents as validation for recommendations on documentation that meets the technical specifications in support of a measure

· Assists with all quality measures initiatives – working with the PCP offices in capturing the data to support the variables.

· Works all Gap reports for 5 STAR and assists with the ACO GPRO quality measures projects as they become relevant and assists with all quality initiatives as needed.

· Process and manage member and provider communications as appropriate to each project.

· Assists in teaching any office staff and/or providers in proper documentation and coding guidelines as necessary

· Reports any issues to Quality, Compliance and Operations as necessary.

· Responds to inquiries regarding this area of expertise.

· Accurately enters all identified and validated measures into the practice’s EMR – if necessary to aid the CCDIs, may enter validated conditions as indicated by the CCDIs into the EMR

· Assists in all RAPS submission projects as they occur if needed in back-up to the CCDIs

· Assist in the preparation of quality and safety data reports for committees and meetings.

· Prepare meeting materials and create meeting quality improvement minutes when warranted

· Performs all other coding and documentation reviews and/or projects as asked and assists/coordinates strategies as defined by the department head or assistant.

Required Skills/Abilities:

· Excellent verbal and written communication skills.

· Excellent organizational skills and attention to detail.

· Excellent time management skills with a proven ability to meet deadlines.

· Proficient with Microsoft Office Suite (Word and Excel) or related software.

· Communication / Coordinate sharing of pertaining information accurately.

· Critical Thinking / Problem solving/Computer

· Has proficient knowledge and experience working with an EHR system.

· Ability to travel.

· Ability to read and analyze medical records.

· Knowledge and understanding of ICD -9/10 , CPT codes and QIP measures – CPC or CSSP is a plus

· Understands documentation, coding and billing guidelines as well as how to read the technical specifications on all quality initiatives.

Supervisor Responsibilities:

· None.

Education and Experience:

Prefer candidate to have some medical record or quality background and current ICD-9/10 coding education. 1-2 years of documentation or medical records experience in any part of the medical continuum. Must demonstrate the ability to utilize Excel and WORD via assessment at interview.

Physical Requirements:

· Prolonged periods of sitting at a desk and working on a computer.

· While performing the duties of this job the employee is regularly required to sit, use hands and arms, talk and hear.

Job Type : Full-time

Salary : $40,000.00 - $50,000.00 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
• Weekend availability

Ability to commute/relocate :

• Orlando, FL 32822: Reliably commute or planning to relocate before starting work (Required)

Experience :

• ISO 9001: 1 year (Required)

Work Location: In person

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