LPN Quality Specialist

Southwest Virginia Community Health Systems•Saltville, VA

About The Position

The Quality Specialist serves as a subject matter expert in value-based payment programs, quality reporting, and population health initiatives. This role is responsible for leveraging payer data, analytics platforms, and clinical collaboration to drive quality performance, close care gaps, and support risk-based reimbursement strategies. This position plays a critical role in optimizing performance in programs such as MSSP, ACO initiatives, and other value-based arrangements by aligning clinical documentation, coding accuracy, and payer reporting.

Requirements

Active LPN/RN License in the Commonwealth of Virginia required.
3+ years of experience in healthcare quality, population health, medical coding, or value-based care programs preferred
Experience in FQHC, ACO, or risk-based reimbursement models strongly preferred

Responsibilities

Analyze and utilize payer quality reports to drive population health strategies and improve clinical outcomes
Identify high-risk, high-utilization patients and support development of team-based care plans
Track organizational performance on quality metrics and identify cost-sharing or incentive opportunities
Partner with care teams to close care gaps and improve HEDIS, UDS, and other quality benchmarks
Serve as a super-user for Azara DRVS and Aledade platforms, including report generation, validation, and issue resolution
Run and interpret monthly and quarterly quality and performance reports
Maintain data integrity and ensure accurate submission to payer portals
Review ICD-10, CPT, and HCPCS coding for accuracy, completeness, and compliance
Validate provider documentation to ensure alignment with diagnoses and services rendered
Provide education and feedback to providers on coding best practices and documentation improvement
Participate in internal audits and quality assurance activities
Ensure timely and accurate completion of medical reports and documentation workflows
Maintain compliance with federal, state, HRSA, and organizational standards
Act as liaison between providers, billing, and payer organizations
Build and maintain relationships with payer representatives to optimize performance and resolve issues
Provide case-specific feedback and education to clinicians and care teams
Stay current on value-based care, healthcare quality, and coding regulations through ongoing education