Quality Improvement Analyst - TMCOne - Quality Assurance

Essential Functions

• Creates and communicates status reports in accordance with departmental standards.
• Updates documentation consistently, following departmental policies and procedures.
• Provides routine interaction with physicians, providers, and coding staff on a daily basis to assist with or resolve issues relating to medical documentation, coding, quality improvement, and clinical outcomes associated with patient care and service to ensure positive results.
• Prepares detailed reports that provide a range of data to assist management in evaluating performance and making recommendations for Accountable Care Organization reports: HEDIS, GPRO, etc.
• Affords assistance with EPIC system analysis and report authorship and design.
• Affords assistance with analyzing business operations and provides recommendations for optimum EPIC system utilization.
• Develops dashboards, reports and analytical models.
• Makes frequent written status updates to customers, team members, and department management.
• Provides superior customer service while reviewing and processing information requests including medical records from patients, physicians, other medical professionals, insurance companies and others.
• Captures and maintains the credentialing and re-credentialing process.

Minimum Qualifications

• Completion of a 2-year college or an equivalent combination of relevant education and experience.
• Bachelor’s degree from an accredited institution in a related field preferred or equivalent experience in a related field preferred.
• Five (5) years of physician office and clinic operations experience.
• Five (5) years of related data management and reporting.

Knowledge, Skills And Abilities

• Knowledge of federal and state requirements as it relates to medical insurance to include Medicare and Medicaid.
• Knowledge of electronic medical records systems, specific experience with EPIC beneficial.
• Skill in computer applications such as basic functionality of the computer, PC File and Folder, Word, EXCEL, Outlook and PowerPoint.
• Ability to read and interpret documents, contracts, proposals, and related legislation.
• Ability to prepare detailed reports and correspondence.
• Ability to listen and accurately interpret others’ communication or instructions and take appropriate action.
• Ability to speak effectively before groups of employees or customers.
• Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs; ability to apply basic algebraic concepts.
• Skill in assessing needs and determining through documentation what the best approach might be.
• Ability to maintain professional working relationships and communication with providers, clinical staff and business office staff, and administration.
• Ability to resolve conflict using judgment, tact, and diplomacy.
• Ability to write correspondence and effectively present information in one-on-one and small group situations to providers, and other employees of the organization.
• Knowledge of medical terminology and coding related to professional billing such as, CPT-4 codes, ICD-9, ICD-10, and HCPCS codes.
• Knowledge of medical records and the evaluation of medical records for out-patient services.
• Ability to identify problems and recommend operations solutions.
• Ability to analyze, interpret, prepare, and present reports to management.
• Ability to accurately perform multiple tasks and observe strict deadlines.