Process Auditing & Record Review: Conduct routine, structured audits of patient case files, member records, and documentation to verify accuracy, completeness, and compliance with institutional standards.
Data Collection & Entry: Accurately extract, compile, and maintain data from various health information systems to support quality scorecards and performance monitoring.
Regulatory Compliance Support: Assist in gathering documentation and prepping audit trails for scheduled state and federal reviews (CMS, DOH, NCQA HEDIS).
Trend Identification: Help monitor operational workflows and flag inconsistencies, documentation gaps, or deviations from established protocols to senior QA team members.
Reporting & Tracking: Maintain internal tracking logs, compile compliance spreadsheets, and assist in drafting basic data summary reports for quality improvement committees.
Cross-Functional Collaboration: Partner with clinical, customer service, and care management teams to clarify documentation inaccuracies and support corrective action plans.
Education: Bachelor’s degree in Healthcare Administration, Public Health, Health Information Management, Business Administration, or a related field.
Experience: 0–2 years of experience in an administrative, analytical, or auditing role. Experience or internships within a healthcare or health insurance setting are highly preferred.
Core Skills:
Exceptional attention to detail and strong organizational skills.
Intermediate proficiency with Microsoft Office Suite (particularly Excel functions like filtering, sorting, and basic data entry formatting).
Ability to handle highly sensitive, confidential patient information with strict adherence to HIPAA guidelines.
Communication: Strong written and verbal communication skills; comfortable reaching out to internal teams to gather or clarify data.
Familiarity with healthcare quality improvement frameworks (e.g., PDSA cycles, Lean concepts).
Basic understanding of Medicaid/Medicare plan structures, HEDIS metrics, or clinical documentation standards.
Comfort learning new electronic health records (EHR) and database management software.
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