Job Description
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.
***This position is Remote but will require occasional travel to centers across South Florida*** Key Duties & Responsibilities: The Quality Improvement (QI) Specialist is responsible for providing 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 Quality education to providers/staff.
• 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 Tags
Full time,