Quality Coordinator
InnovaCare Health
Premier Health Network, LLC
Job Title: Quality Care Coordinator
Job Summary: The role of the Quality Coordinator is performing audits on all medical records contained in ours health care facilities. Also known as medical auditors, they review the data to ensure the accuracy of the record as well as assess the quality of patient care. Medical reviewers must complete at least a two-year associate's degree through a technical school or community college. These skills include, but are not limited to, positive relationship building, effective written/verbal communication, and ability to effect change, perform critical clinical analysis, plan and organize effectively reports. It is crucial for the Quality Coordinator to have knowledge of CMS stars rating process, Medicaid Quality measures programs and clinical standards and outcomes.
Responsibilities:
Daily review next day of assigned provider’s Cap patients.
Daily review next day Quality actions found previous day Caps patients.
Responsible for coordination of care regarding quality gaps measures pending with our office managers and QI director.
Responsible for coordination of any Quality gaps measures events with QI director.
Responsible for coordination of Quality Chart review request from insurance companies in the offices.
Responsible to coordinate with office managers any medical records from Hospital, specialist visit and/or SNH for office follow up missing in chart.
Identified and follow up with billing department medical assistant’s documentation errors regarding quality measures.
Send to QI Director Spreadsheet report on time for process.
Responsible for keep our EHR system (ECW ) up to date as: • Identified and correct any patient’s information error. • Quality Spreadsheet • CDSS/Alerts • Quality Global Alerts • Arcadia Quality Measures Portal.
Skills and Specifications
• Comprehensive Chart Review abstraction based on current CMS Star Rating Medicaid Quality programs .
• Capable to do clinical correlations to increase quality care of our members .
• Critical Thinking / Problem solving/Computer / EHR system (ECW preferred)
• Clinical background including disease and case management protocols.
• Providers advocacy and empowerment /Conference and meetings
• MD Degree (Foreign Physician)
• Up to 2 years Stars Rating /Medicaid Quality measures experience
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