Clinical - Quality Improvement Auditor Clinical
Clinical - Quality Improvement Auditor Clinical
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Job Description
Position Title: Quality Improvement Auditor
Location: Remote
Duration: 6 Months
Schedule: 08:00am/5:00pm AZ time with 1 hour lunch Mon Fri. There may be instances of required OT when approved by management
Job Description:
The role involves reviewing medical records to ensure compliance with HEDIS (Healthcare Effectiveness Data and Information Set) measures. This position is crucial in collecting and validating data that influences healthcare quality metrics.
NOTE: Must pass HEDIS measure testing prior to week 3
DaytoDay Responsibilities
- Medical Record Review:
- Systematically assess 50 100 medical records daily.
- Verify that records meet HEDIS standards for specific measures.
- Document findings accurately and comprehensively.
- Data Collection and Analysis:
- Gather associated data relevant to HEDIS measures.
- Enter data into appropriate databases or reporting systems.
- Collaboration and Communication:
- Work closely with healthcare teams to clarify records and resolve discrepancies.
- Communicate findings and recommendations to ensure quality improvement.
- Quality Assurance:
- Participate in quality assurance activities including peer reviews and audits.
- Ensure accuracy of data with a target of 95% or better.
- Ongoing Training and Development:
- Engage in continuous education on HEDIS standards and healthcare regulations.
Performance Expectations/Metrics
- Record Review Volume: Successfully review between 50100 medical records per day.
- Accuracy Rate: Maintain a minimum accuracy rate of 95% in record assessments and data entry.
- Timeliness: Meet project deadlines and respond promptly to inquiries and corrections.
First Day Overview
- Welcome Meeting: Introduction to the organization team members and overview of the project.
- Training: Structured training throughout the first week focusing on HEDIS measures record review processes and tools used.
- Subject Matter Expert (SME) Training: In the second week deeper training sessions led by SMEs to enhance understanding of specific HEDIS measures.
- Project Assignment: By weeks 34 individuals will begin handling assigned projects with close oversight for quality assurance to ensure accuracy and compliance.
Background and Qualifications
Ideal candidates might come from the following roles:
- Healthcare Auditor: Experience in auditing healthcare records for compliance.
- RN LPN LVN: Clinical background providing a strong understanding of medical records.
- Quality Management/Quality Improvement: Experience focusing on healthcare quality metrics.
- Compliance: Background ensuring adherence to regulations and standards.
- HEDIS Auditor/Coordinator: Direct experience with HEDIS measures and processes.
Employment Type
Full Time
