Healthcare Quality Audit Specialist

20 hours ago

Karachi, Sindh, Pakistan MacCare Full time 400,000 - 800,000 per year

Summary:

The Quality Support Specialist will uphold the highest quality care for all assigned patients, understanding the regulatory reporting requirements for quality measure compliance. This role will assist the organization in staff training, coordination, and outreach events, as well as documented compliance with quality measures in accordance with HEDIS and/or payor quality requirements.

The Quality Support Specialist will report to the Senior Manager of Quality Improvement-Population Health. The Population Health Team is committed to supporting IntraCare's network of primary care physicians to achieve improvements in patient care outcomes and financial rewards related to value-based care. Population Health Team members must have a passion for patient care and creative innovation and insight into programs that support the company's goals and initiatives.

Key Responsibilities:

  • Coordinates with medical practices and providers with recommendations for health screenings, patient assessments and well care visits.
  • Supports provider practices by identifying workflow gaps, trends and suggesting best practice initiatives to improve performance in clinical and quality metrics.
  • Tracks all tasks closely to completion and reports progress in order to ensure positive performance results.
  • Collects and enters data with high attention to detail. Documents information completely, accurately, and in a timely manner. Keeps records of interactions, demographic updates, and other key details as well as presents those records when requested by the Population Health Team.
  • Builds and maintains professional relationships with individuals and organizations that can support IntraCare's goals including, but not limited to health plan representatives, provider practices, and internal departments.
  • Accurately and efficiently conducts medical record review and abstraction with respect to the given guidelines of CMS and/or payor requirements. Scans/downloads relevant components from the medical record to support reviews performed.
  • Achieves assigned targets/goals on daily/weekly/monthly basis
  • Works collaboratively with Network and MSO departments to improve quality results.
  • Maintains confidentiality and adheres to HIPAA requirements including communication procedures, guidelines, and policies.
  • Proactively escalates gaps and issues of attention to supervisor or designated business owner.
  • Other duties as assigned.

Required Qualifications:

  • High School Diploma
  • Ability to multi-task and work under narrow timelines
  • Basic understanding of the healthcare industry
  • Professional conduct and communication skills set with basic English language
  • 1+ years of working experience with Microsoft Word and Excel
  • Software literate to grasp different interfaces of different EMRs
  • Demonstrated ability to work independently toward established goals
  • Target orientated personality and attitude
  • Keen to learn and expand knowledge within the industry.

Preferred Qualifications:

· EMR (Electronic Medical Records) knowledge and experience

  • Relevant experience in the healthcare industry

· Familiarity with medical terminology

  • 1+ years of HIPAA compliance requirements knowledge

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