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Stack/tools: ICD-9/ICD-10, CPT, documentation and billing guidelines; 5 STAR, PQRS, HEDIS, CMS coding guidelines; EMR; Microsoft Word & Excel; basic quality improvement tools; ability to travel.
Top 3 responsibilities
Support quality assessment, monitoring, evaluation, and performance improvement projects; manage data capture for quality measures.
Assist with 5 STAR, ACO GPRO measures, RAPS submissions, and other quality initiatives; validate documentation per approved sources.
Educate providers/staff on proper documentation and coding; prepare reports, meeting materials, and quality improvement minutes.
Must-have skills
Excellent written/verbal communication; strong organizational and time-management skills.
Proficiency with EMR, Excel, and Word; ability to analyze medical records and read coding/docs.
Knowledge of ICD-9/10, CPT, and QIP measures; understanding of documentation, coding, and billing guidelines.
Ability to work independently, meet deadlines, and travel as needed.
Nice-to-haves
CPC or CSSP certification; prior medical records/quality background; experience with data reporting for committees.
Location & work type: Remote, full-time; 8-hour day shift, Monday–Friday; must be able to travel.
Full Description
Overview
The role of the Quality Assurance Coordinator (QA Coordinator) is to monitor and audit medical record documentation, coding and quality measures for compliance and accuracy. It is critical for the QA Coordinator to have knowledge of 5 STAR, PQRS, HEDIS, CMS coding guidelines, and coding/documentation and billing standards and regulations.
The QA Coordinator uses their knowledge of ICD-9/ICD-10, CPT, and documentation guidelines as well as billing knowledge to assist in any and all coding and documentation audits and/or billing functions as determined by the Compliance, Operations, and/or Quality department(s). Additionally, the QA Coordinator participates in company-wide quality initiatives.
Key Duties & Responsibilities
The QA Coordinator is responsible for providing support for quality assessment and performance improvement activities that include quality monitoring, evaluation and facilitation of performance improvement projects.
Follows most recent documentation and coding guidelines
Uses only pre-approved source documents as validation for recommendations on documentation that meets the technical specifications in support of a measure
Assists with all quality measures initiatives – working with the PCP offices in capturing the data to support the variables.
Works all Gap reports for 5 STAR and assists with the ACO GPRO quality measures projects as they become relevant and assists with all quality initiatives as needed.
Process and manage member and provider communications as appropriate to each project.
Assists in teaching any office staff and/or providers in proper documentation and coding guidelines as necessary
Reports any issues to Quality, Compliance and Operations as necessary.
Responds to inquiries regarding this area of expertise.
Accurately enters all identified and validated measures into the practice’s EMR – if necessary to aid the CCDIs, may enter validated conditions as indicated by the CCDIs into the EMR
Assists in all RAPS submission projects as they occur if needed in back-up to the CCDIs
Assist in the preparation of quality and safety data reports for committees and meetings.
Prepare meeting materials and create meeting quality improvement minutes when warranted
Performs Quality education to providers/staff.
Performs all other coding and documentation reviews and/or projects as asked and assists/coordinates strategies as defined by the department head or assistant.
Required Skills/Abilities
Excellent verbal and written communication skills.
Excellent organizational skills and attention to detail.
Excellent time management skills with a proven ability to meet deadlines.
Medical Record Documentation AuditingCoding Compliance5 STAR KnowledgePQRS KnowledgeHEDIS KnowledgeCMS Coding GuidelinesICD-9/ICD-10CPT CodingBilling StandardsQuality Initiatives ParticipationPerformance ImprovementEHR System ProficiencyData EntryReport PreparationQuality EducationCommunicationmulti-location
Proficient with Microsoft Office Suite (Word and Excel) or related software.
Communication / Coordinate sharing of pertaining information accurately.
Critical Thinking / Problem solving/Computer
Has proficient knowledge and experience working with an EHR system.
Ability to travel.
Ability to read and analyze medical records.
Knowledge and understanding of ICD -9/10 , CPT codes and QIP measures – CPC or CSSP is a plus
Understands documentation, coding and billing guidelines as well as how to read the technical specifications on all quality initiatives.
Supervisor Responsibilities
None.
Education and Experience
Prefer candidate to have some medical record or quality background and current ICD-9/10 coding education.
1-2 years of documentation or medical records experience in any part of the medical continuum.
Must demonstrate the ability to utilize Excel and WORD via assessment at interview.
Physical Requirements
Prolonged periods of sitting at a desk and working on a computer.
While performing the duties of this job the employee is regularly required to sit, use hands and arms, talk and hear.
Must be able to lift up to 10 pounds at times.
Benefits
Health insurance
Dental Insurance
Vision insurance
Life insurance
401(k)
Paid time off
Schedule
8 hour shift
Day shift
Monday to Friday
Job Type: Remote / Full-time
Palm Medical Centers is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm Medical Centers makes hiring decisions based solely on qualifications, merit, and business needs at the time.
