PACE Quality Analyst

AtlantiCare•Atlantic City, NJ

About The Position

The Quality Analyst serves to strengthen regulatory compliance, quality performance, participant safety and data integrity within the PACE program. This position will serve as a key liaison between interdisciplinary teams, external providers and regulatory bodies to ensure medical records are complete, timely, and compliant with state & CMS standards. The Quality Analyst will act as the bridge between Health Information Management (HIM) operations and Compliance oversight, ensuring participant data integrity, HIPAA adherence, and regulatory readiness through proactive monitoring, organizational audits, and interdepartmental coordination & education. This role supports compliance with CMS 460.60, PACE documentation standards, and AtlantiCare’s Quality and Compliance program goals. In collaboration with the LIFE Connection quality/compliance team, this role has the following responsibilities:

Requirements

Bachelor’s degree required with 5 years job related field experience.
Proficiency in Microsoft Suite with strong focus on Microsoft Excel
EMR proficiency (Cerner, PACE Logic, or equivalent).
5 years’ experience in medical records coordination, compliance, or quality oversight (PACE/LTC/Home Care Preferred)
Must possess a comprehensive understanding of CMS regulations, HIPAA Privacy & Security Rules, and documentation standards.
Must possess strong analytical & organizational skills, with attention to regulatory detail.

Responsibilities

Interpret and apply CMS, HIPAA, and NJ DOH regulations to participant record management, retention, and access.
Develop, maintain, and implement policies and procedures for medical record documentation and compliance activities.
Perform internal audits of participant medical records, tracking timeliness, completeness, accuracy, and regulatory compliance.
Conduct comprehensive chart reviews to identify all clinically relevant, CMS –acceptable diagnosis for HCC capture.
Collaborate with finance, quality and clinical departments to ensure HCC coding accuracy based upon CMS Risk Adjustment Guidelines.
Stay current with annual HCC model changes, ICD-10 updates, CMS Memos, NPA Guidance and Audit trends.
Serve as the primary compliance liaison for all HIM-related activities, supporting audits, process improvements and surveys.
Coordinate secure data exchange with hospitals and contracted facilities through HIE or direct methods to ensure record exchange compliance and interdisciplinary documentation consistency.
Ensure consistency between care plans, MARs, and progress notes through regular reconciliation.
Develop compliance and HIPAA training materials for staff; lead education sessions on documentation best practices.
Educate providers on risk-adjusted documentation standards, specificity requirements, and annual condition re-assessment rules.
Assist with investigation and reporting of privacy breaches, documenting corrective actions per CMS and HIPAA standards.
Support implementation and optimization of EHR systems (Cerner, PACE Logic) to enhance data accuracy, efficiency and compliance tracking.
Generate data dashboards and reports on audit trends, compliance metrics, and corrective action outcomes for QA Committee review.
Provide data abstraction for QAPI indicators and trend analysis for quality performance improvement and reporting.
Assist with the creation & monitoring of PDCAs in place for quality & process improvement.
Monitor & mediate corrective action plans & immediate corrective action plans that were developed from regulatory deficiencies & CMS Audits.