Quality Management Specialist

Date Posted: May 10, 2021

Deadline: June 25, 2021

Organization: New Horizon Family Health Services

Location: Greenville Area

City: Greenville

Website: View Website

Job Type: Full Time

Requirements:

ducation:

A minimum of Bachelor’s degree from an accredited college or university in a related field
OR

Licensed Practical Nurse
OR

HS Diploma and 10 years experience in related healthcare employment:
Direct Patient Care and/or Provider Support
Quality Management and Compliance Reporting
Knowledge of Patient Outcome Measures and Requirements
Certification in Medical Coding
AAPC designation preferred


Experience:

¨ Two years work experience in a health care setting preferred.

¨ Experience with data collection, compilation and analysis preferred.

¨ Experience with EHR and Practice Management Software preferred.



Other Requirements:

¨ Must demonstrate ability to accept responsibility as indicated.

¨ Must be flexible; capable of performing a variety of duties.

¨ Must demonstrate good communication skills including legible handwriting, spelling accuracy, ability to speak clearly with correct grammar.

¨ Must be proficient in use of personal computer and other office equipment including Microsoft Office.

¨ Must present a neat appearance and have a courteous and tactful manner.

¨ Must demonstrate the ability to work under stress and work well with others.

¨ Participates in CQI, other internal committees, special project / observances or activities that promote improvements in organizational performance and / or advance the mission, goals and objective of NHFHS.

¨ Contributes constructive ideas for a more efficient organization.

Job Description:

The Quality Management Specialist works under the direct supervision of the Quality Management and Compliance Director. This position provides support to the organization in the areas of Compliance and Quality Management. Areas of focus will include:

Quality Measures: Patient Outcome Data, UDS, HEDIS, meaningful use, and PCMH

Revenue Cycle Management: Coding, Collections, and Billing performance / process improvement.

DUTIES PERFORMED:

Collect and review data related to Clinical Quality Measures to assist the Quality Management and Compliance Director in monitoring patient outcome data. These clinical measures include, but are not limited to UDS, HEDIS, meaningful use, and PCMH requirements.
Assists / conducts reviews as necessary for FTCA, PCMH, UDS, and other internal / external requirements to meet recognition/certification for organization.
Serves as a data miner of EHR / Practice Management / Practice Analytics for Quality Management Department in support of Clinical / Administrative staff for the organization.
Assist Compliance Officer and the Revenue Cycle Manager in continuing development and internal compliance review and monitoring relative to coding, billing and revenue cycle activities.
Assist Quality Management and Compliance Director in tracking, trending, and reporting of event data within the Event Reporting Process.
Develop classes and other training resources relative to quality improvement needs identified through ongoing monitoring including EHR transition/implementation /training.
Utilize results to support implementation of Process Improvement and conduct PDSAs in areas identified as needing improvement.
Monitor Office of Inspector General (OIG) fraud alerts and other regulatory updates and implement necessary changes/education of staff.
Build and support the infrastructure for collaboration between clinical and revenue cycle staff.
Assist in planning and organization of the Coding Compliance Program that involves a review of specific coding and documentation requirements.
Work closely with the regional Best Chance Network coordinator to ensure billing is completed and submitted to the program efficiently.
Collect, track, and trend revenue cycle data to support RCM activities by performing a periodic review of revenue cycle measures and preparing data reports.
Collect and review data related to Practice Support Quality Measures to assist the Quality Management and Compliance Director in monitoring business practice data. These measures include, but are not limited to patient cycle time, third next appointment availability, patient satisfaction data, productivity, and revenue cycle activities.
Prepare and present outcome data to CQI committees on a monthly basis.
Prepare and present outcome data to the New Horizon staff on a quarterly basis. This data is to be presented in an easy to interpret/review manner and is readily accessible to any staff member.
Support the clinical team in quality improvement activities by providing data to track and trend the effects of PDSA implementation.
Perform record reviews focused on accuracy of coding and provide clear reports to management within established guidelines and deadlines.
Perform PSR/front desk record reviews focused on accuracy of sliding fee determination and other PSR measures.
Assist Compliance Officer and the Revenue Cycle Manager in continuing development and internal compliance review and monitoring relative to coding, billing and revenue cycle activities.
Assist Quality Management and Compliance Director in tracking, trending, and reporting of event data within the Event Reporting Process.
Develop classes and other training resources relative to quality improvement needs identified through ongoing monitoring including EHR transition/implementation /training.
Utilize results to support implementation of Process Improvement and conduct PDSAs in areas identified as needing improvement.
Monitor Office of Inspector General (OIG) fraud alerts and other regulatory updates and implement necessary changes/education of staff.
Build and support the infrastructure for collaboration between clinical and revenue cycle staff.
Assist in planning and organization of the Coding Compliance Program that involves a review of specific coding and documentation requirements.
Work closely with the regional Best Chance Network coordinator to ensure billing is completed and submitted to the program efficiently.
Collect, track, and trend revenue cycle data to support RCM activities by performing a periodic review of revenue cycle measures and preparing data reports.

Schedule:
Contact Name:
Nancy Cutler
Contact Phone Number: 8647298330
Program(s):
Application Process:
Apply on company website at newhorizonfhs.org
Go to the career page

Email - hrdept@newhorizonfhs.org
Employer Address:

975 W. Faris Rd
Greenville, SC 29605
United States

Our organization does not discriminate on the basis of race, color, religion, national origin, age, sex, sexual orientation, or disability.