Quality Assurance (QA) Specialist

Job Description

Job Description

Position Summary: 

The HGB Program Quality Assurance Specialist plays a critical role in ensuring every patient encounter is documented accurately and completely prior to claim submission. This position serves as the final quality checkpoint by auditing medical documentation, validating compliance with Medicare guidelines, and ensuring operational excellence across all HGB program locations.

The ideal candidate is highly detail-oriented, experienced in clinical documentation, and understands the importance of compliance, quality, and accurate reimbursement.

Primary Responsibilities: 

• Audit 100% of patient encounters for documentation accuracy and completeness.
• Review all documentation before claims are submitted to ensure billing readiness.
• Verify that required clinical documentation supports all services performed.
• Ensure compliance with Medicare regulations, documentation standards, and company protocols.
• Identify documentation deficiencies and communicate required corrections to providers and clinical staff.
• Monitor quality trends and recommend process improvements.
• Maintain detailed QA audit logs and reporting.
• Participate in ongoing quality improvement initiatives.
• Travel throughout Texas as needed to support clinic audits and training.

Qualifications:

Required: 

• Minimum 2 years of experience working in a clinical setting.
• Minimum 1 year of experience working with Medicare guidelines, documentation requirements, and quality metrics.
• Strong understanding of clinical documentation standards.
• Exceptional attention to detail.
• Strong written and verbal communication skills.
• Ability to prioritize multiple tasks while meeting deadlines.
• Willingness to travel throughout Texas as needed.

Preferred: 

• Experience with EMR/EHR systems.
• Medical coding or billing knowledge.
• Quality assurance or auditing experience.

Skills: 

• Clinical documentation review.
• Medicare compliance.
• Critical thinking.
• Problem-solving.
• Organization.
• Time management.
• Microsoft Office proficiency.

Compensation & Benefits: 

• $20.00–$24.00 per hour.
• Part-Time position with growth opportunities.
• Mileage reimbursement for approved travel.
• Professional development opportunities.