Quality Management Specialist
About The Position
The Quality Management Specialist works under the direct supervision of the Quality Management and Compliance Director. This position provides support to the organization in the areas of Compliance and Quality Management. Areas of focus will include: Quality Measures: Patient Outcome Data, UDS, HEDIS, meaningful use, and PCMH; Revenue Cycle Management: Coding, Collections, and Billing performance / process improvement. The Sliding Fee Quality Control Auditor Specifications include assisting Compliance Officer, Revenue Cycle Manager, and Practice Managers in continuing development and internal compliance review and monitoring relative to the Sliding Fee Program and PSR training. This role will perform PSR/front desk record reviews focused on accuracy of sliding fee determination and other PSR measures, collect, track, and trend data to support staff training and improvement, initiate and support quality improvement projects to ensure continuous quality improvement, organize and assist in staff trainings, assist in the collection and reporting of data for UDS, PCMH, FTCA, etc., and develop and perform scheduled audits to ensure grant and contractual compliance.
Requirements
- High School Diploma and 10 years’ experience in related healthcare employment
- Direct Patient Care and/ or Provider Support
- Front Desk/ Patient Check-In
- Quality Management and Compliance Reporting
- A minimum of Bachelor’s degree from an accredited college or university in a related field
- Two years’ work experience in a healthcare setting
- Experience with data collection, compilation and analysis
- Experience with EHR and Practice Management Software
- Audit, training, and compliance experience
Nice To Haves
- Certification in Medical Coding; AAPC designation
Responsibilities
- Collect and review data related to Clinical Quality Measures to assist the Quality Management and Compliance Director in monitoring patient outcome data. These clinical measures include, but are not limited to UDS, HEDIS, meaningful use, and PCMH requirements.
- Assists / conducts reviews as necessary for FTCA, PCMH, UDS, and other internal / external requirements to meet recognition/certification for organization.
- Serves as a data miner of EHR / Practice Management / Practice Analytics for Quality Management Department in support of Clinical / Administrative staff for the organization.
- Collect and review data related to Practice Support Quality Measures to assist the Quality Management and Compliance Director in monitoring business practice data. These measures include, but are not limited to patient cycle time, third next appointment availability, patient satisfaction data, productivity, and revenue cycle activities.
- Prepare and present outcome data to CQI committees on a monthly basis.
- Prepare and present outcome data to the New Horizon staff on a quarterly basis. This data is to be presented in an easy to interpret/review manner and is readily accessible to any staff member.
Benefits
- Vacation plus holidays and sick leave
- Medical (PEBA State Health Plan), Dental and Vision benefits
- Flexible Spending and Health Savings Accounts
- Voluntary Life Insurance
- Short Term Disability and Long Term Disability
- Optional contribution to a 403 (b) Retirement Plan, with up to 4% employer match after the first year of employment
- Continuing education courses through SC AHEC
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
