Quality Assurance Coordinator

Monitor and audit medical record documentation, coding, and quality measures for compliance and accuracy. Knowledge of 5 STAR, PQRS, HEDIS, CMS coding guidelines, and coding/documentation and billing standards and regulations is critical. Use expertise in ICD-9/ICD-10, CPT, and documentation guidelines to assist in coding, documentation audits, and billing functions as determined by Compliance, Operations, and/or Quality departments. Participate in company-wide quality initiatives.

Responsibilities

• Provide support for quality assessment and performance improvement activities, including quality monitoring, evaluation, and facilitation of performance improvement projects.
• Follow the most recent documentation and coding guidelines.
• Use only pre-approved source documents as validation for recommendations on documentation that meets technical specifications in support of a measure.
• Assist with all quality measures initiatives, working with PCP offices to capture data supporting the variables.
• Work all Gap reports for 5 STAR and assist with ACO GPRO quality measures projects as they become relevant.
• Process and manage member and provider communications as appropriate to each project.
• Assist in teaching office staff and/or providers proper documentation and coding guidelines as necessary.
• Report any issues to Quality, Compliance, and Operations as needed.
• Respond to inquiries regarding areas of expertise.
• Accurately enter all identified and validated measures into the practice’s EMR; may enter validated conditions as indicated by the CCDIs into the EMR.
• Assist in all RAPS submission projects as needed in backup to the CCDIs.
• Assist in the preparation of quality and safety data reports for committees and meetings.
• Prepare meeting materials and create quality improvement meeting minutes when warranted.
• Perform quality education for providers and staff.
• Perform all other coding and documentation reviews and/or projects as requested and assist/coordinate strategies as defined by the department head or assistant.

Requirements

• 1-2 years of documentation or medical records experience in any part of the medical continuum.
• Prefer candidate with medical record or quality background and current ICD-9/10 coding education.
• Must demonstrate the ability to utilize Excel and Word via assessment at interview.
• 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 certification is a plus).
• Understands documentation, coding, and billing guidelines, as well as how to read technical specifications on all quality initiatives.

Skills

• 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.
• Critical thinking and problem-solving abilities.
• Strong computer skills.

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.
• Must be able to lift up to 10 pounds at times.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• 401(k)
• Paid time off

Schedule

• 8-hour shift
• Day shift
• Monday to Friday

Hybrid position.