Clinical Quality Analyst Job Description Template
Our company is looking for a Clinical Quality Analyst to join our team.
Responsibilities:
- Completes quarterly progress/performance reports;
- Develops and monitors corrective actions;
- Generates scorecards for each hospital. Provides feedback to practitioners on performance;
- Conducts provider on-site audits by researching provider clinical quality issues;
- Maintains hospital quality database via requests for information and questionnaires;
- Maintain professionalism and a positive service attitude at all times;
- Coordinate with supervisor to develop and present reports of medical record reviews to present to physician’s office staff;
- Analyze facts and exercise sound judgement when arriving at conclusions;
- Evaluate and provide feedback to improve performance of clinic staff with DataMining techniques;
- Effectively report data, facts and recommendations in oral and / or written form;
- Ability to multi-task in a fast paced and deadline driven environment;
- Performs other related duties as assigned;
- Analyze errors in submission sent to quality department by physician office and notify Supervisor for process improvement plan;
- Review medical record documents and other clinical documentation in provider’s charts to identify possible risk adjustment codes.
Requirements:
- Excellent organizational skills and strong attention to detail;
- Flexibility and willingness to shift priorities as often as needed to minimize issues or meet market goals and objectives;
- 2+ years of related healthcare experience;
- RN or non-licensed medical school graduate;
- Knowledgeable in risk adjustment coding;
- Bilingual in Spanish;
- Experience with proprietary medical coding systems;
- 2+ years of experience working with Medicare / Medicaid;
- Knowledge of human anatomy and physiology;
- Familiar with medical review process;
- Experience in a clinical setting;
- Knowledge of medical terminology;
- Knowledge of Quality Metrics and risk adjustment coding;
- Familiarity with ICD-9 and / or ICD-10 codes;
- Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area.