Healthcare Quality & Compliance Analyst

Quality And Compliance Administrator Under general supervision of the Quality and Compliance Administrator, develops and conducts complex quality studies by analyzing data, validating data accuracy, and evaluating / defining processes according to department criteria, external review organizations, and other regulatory agencies. This job class is treated as FSLA Exempt. Essential Functions In assigned Specialty areas, conducts regular chart audits and shares results with department area managers/directors. Works on more complex studies in which analysis of situations or data requires an in-depth evaluation of various factors including processes and QM program / interventions. Completes monthly progress/performance reports or presentations. Provides feedback to Practitioners and Management on performance through the creation of balanced scorecards. Works with department area managers to ensure high levels of patient satisfaction. Prepares department for oversight audits. Prepares corrective action plans in response to internal and/or oversight body's request. Conducts audits of QM processes and data files. Collaborates with and participates in the quality department to provide consultation and advice to management related to program, policy and procedure development and contributes to process improvements and solutions. Coordinates the collection and organization of identified KPIs and documents according to department criteria, external review organizations, and other regulatory agencies. Participates in development and design of audit tools, policies and procedures, and provider manuals. Performs in-depth analysis of healthcare data coupled with data other sources to independently design, develop, and deliver analytic deliverables to meet quality, cost and service objectives. Participates in process improvement process that includes activities such leading workgroups, facilitating training sessions, and measuring improvements. Queries data bases to extract information needed to develop reports. Collects, analyzes and interprets data using established definitions and guidelines. Researches patient data across multiple applications to extract clinical documentation for assessment. Supports the development of standard reports and processes. Works with service lines to identify opportunities to enhance existing and to develop new data information processes and tools. Coordinates or independently completes special projects. Assists staff members with more complex and detailed projects and analyses which support continuous quality improvement leading to actionable information. Actively participates in Quality Assurance and any other Committees as assigned. Adheres to HIPAA compliance, privacy and confidentiality standards of HHS and the River Peoples' Health Center. Maintains documented inventory of existing reports, clinical review and data validation of records to identify data trends. Support end-user training; design and implement educational and clinical services program. Monitor and report data as related to the EHR and clinical software applications. Perform related duties as required. Knowledge, Skills, Abilities and Other Characteristics Knowledge of the history, culture, laws, customs, and traditions of the Salt River Pima-Maricopa Indian Community. Knowledge of medical records management systems, both physical and electronic. Knowledge of EHR, EMR and other related clinical software. Knowledge of procedure codes and processes for healthcare treatment. Knowledge of medical terminology and healthcare workflow processes. Knowledge of performance improvement models and root cause analysis. Skill in analyzing data, from multiple sources (including paper charts, software applications, databases, etc.) collaboratively. Skill in solving complex problems through the use of a combination of delivered and custom-developed tools. Skill in time management and organization. Skill in interpersonal communication and collaboration. Ability to code, compile and categorize, and verify information/data. Ability to work independently, take initiative and use judgment. Ability to meet and comply with HIPAA/Confidentiality policies and procedures and ability to handle highly confidential and sensitive patient and financial information. Ability to complete work assignments and special projects in a timely manner. Ability to communicate efficiently and effectively to train large numbers of staff. Ability to handle difficult situations with patients, providers, and other in a professional manner. Ability to work with technology to extract and manipulate data. Minimum Qualifications Education & Experience: Bachelor of Arts or Science in a health or business related field required. Experience: Three (3) years of healthcare quality analytics or performance improvement experience required. Intermediate to advanced level skills in Microsoft Office Suite (Outlook, Excel, Word, and PowerPoint). Equivalency: Any equivalent combination of education and experience that will allow the applicant to satisfactorily perform the duties of the job may be considered. Underfill Eligibility: An enrolled Community Member whom closely qualifies for the minimum qualifications for a position may be considered for employment under SRPMIC Policy 2-19, Underfill. Special Requirements Due to the confidential and sensitive nature of this position, successful completion of an extensive background investigation is required. Employees in, and applicants applying for, jobs providing direct services to children are subject to the "Community code of Ordinances", Chapter 11, "Minors", Article X. "Investigation of Persons Working with Children". Ensures all patient information is kept confidential and complies with Health Insurance Portability and Accountability Act (HIPAA) regulations and SRPMIC HHS policies and procedures. Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check. Equal Opportunity Statement SRPMIC is an Equal Opportunity/Affirmative Action Employer. Preference will be given to a qualified Community Member Veteran, Community Member, Spouse of Community Member, qualified Native American, and then other qualified candidate. #J-18808-Ljbffr Salt River Pima-Maricopa Indian Community