Quality Lead

J29, Inc•Millersville, MD

20d•$85,000 - $100,000•Remote

About The Position

This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change. About J29 At J29, we believe in empowering our employees to do great things for the benefit of others. Our culture is built on purpose, service, and impact — not just for our clients, but for our communities. We are a mission-driven, people-first organization that believes in a strong culture, thoughtful leadership, and meaningful philanthropy that are inseparable from business success.

Requirements

5+ years of experience and extensive knowledge of the Medicare program, medical review experience, and quality assurance experience.
3+ years of experience serving as a highly-proficient medical record reviewer, with demonstrated efficiencies or lessons-learn brought to respective team.
3+ years in a Team Lead, Auditor, or QA Analyst/Lead role that was tasked with various types of auditing/QA of Medicare claims/records.

Responsibilities

Conduct random quality checks, staff in-services, QA meetings, and monthly inter-reviewer reliability testing.
Track and monitor QA activities, including hours spent, personnel involved, and methodologies used.
Ensure consistency and accuracy in all accuracy reviews, special studies, and new issue reviews.
Participate in and oversee QA audits of reviewers to ensure cases are reviewed in accordance with contract and regulatory requirements.
Prepare and submit monthly and annual reports on all internal contractor QA activities.
Provide clear overviews of QA methodologies, findings, corrective actions, and outcomes.
Ensure all QA deliverables are Section 508 compliant and properly formatted.
Verify that all reviews and QA activities comply with CMS policies, Medicare regulations, and applicable laws (e.g., HIPAA, FISMA).
Stay current with changes in medical practice, technology, and policy that may impact QA processes.
Research and validate all references and policies used in QA reviews to ensure they are up to date.
Develop and deliver training modules to educate staff on Medicare coverage and payment policies, QA procedures, and review standards.
Identify errors, vulnerabilities, and patterns in review findings.
Document lessons learned and provide instructions to strengthen future accuracy reviews and QA processes.
Work closely with the Program Manager, Contractor Medical Director, and Medical Review Manager to ensure QA objectives are met.
Ensure continuity of QA operations in the event of personnel changes, including maintaining qualified backups.