Quality Reviewer
About The Position
The Quality Reviewer is responsible for overseeing quality reporting processes to payers, including in-office assessments (IOAs). This position involves attending regular meetings with payers to review data and identify opportunities for improvement. Responsibilities include collecting and analyzing health data to identify trends and gaps in care, ensuring compliance with regulations such as HEDIS and CMS guidelines, and providing feedback to healthcare practices to enhance quality outcomes. Additionally, the role involves tracking performance by chart auditing clinical staff, metrics related to population health initiatives and reporting findings to leadership. This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation. The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
Requirements
- High school diploma or equivalent
- Minimum 3 years’ experience required within an ambulatory care setting required
- Valid driver’s license required
Nice To Haves
- Certified Medical Assistant preferred
Responsibilities
- Overseeing quality reporting processes to payers, including in-office assessments (IOAs)
- Attending regular meetings with payers to review data and identify opportunities for improvement
- Collecting and analyzing health data to identify trends and gaps in care
- Ensuring compliance with regulations such as HEDIS and CMS guidelines
- Providing feedback to healthcare practices to enhance quality outcomes
- Tracking performance by chart auditing clinical staff
- Tracking metrics related to population health initiatives and reporting findings to leadership
- Providing quality customer service
- Participating in performance improvement efforts
- Demonstrating a commitment to teamwork and cooperation
Benefits
- Generous Paid Time Off (PTO)
- Medical, Prescription Drug, Dental & Vision Insurance
- Retirement Plans with employer contributions
- Short-Term & Long-Term Disability Coverage
- Life & Accidental Death & Dismemberment Insurance
- Tuition Reimbursement to support your educational goals
- Flexible Spending Accounts (FSAs) for healthcare and dependent care
- Wellness Programs to help you thrive
- Voluntary Benefits, including Pet Insurance and more
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
