Quality Management Specialist

JOB TITLE: Quality Management Specialist - Sliding Fee Quality Control Auditor

JOB SUMMARY:

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.

Sliding Fee Quality Control Auditor Specifications:

• Assist Compliance Officer, Revenue Cycle Manager, and Practice Managers in continuing development and internal compliance review and monitoring relative to the Sliding Fee Program and PSR training.

• Perform PSR/front desk record reviews focused on accuracy of sliding fee determination and other PSR measures.

• Collect, track, and trend data to support staff training and improvement.

• Initiate and support quality improvement projects to ensure continuous quality improvement

• Organize and assist in staff trainings to include, but not limited to, PSR training.

• Assist in the collection and reporting of data for UDS, PCMH, FTCA, etc.

• Develop and perform scheduled audits to ensure grant and contractual compliance

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.
• 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.

QUALIFICATIONS:

• EDUCATION:

• REQUIRED:

• High School Diploma and 10 years' experience in related healthcare employment

• Direct Patient Care and/ or Provider Support

• Front Desk/ Patient Check-In

• Quality Management and Compliance Reporting

OR

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

• PREFERRED:

• Certification in Medical Coding; AAPC designation

• EXPERIENCE:

• PREFERRED:

• Two years' work experience in a healthcare setting

• Experience with data collection, compilation and analysis

• Experience with EHR and Practice Management Software

• Audit, training, and compliance experience

Benefits:

New Horizon Family Health Services offers a robust and comprehensive benefit package to full time employees. These choices/options include:

• Vacation plus holidays and sick leave

Optional Benefits which include:

• Medical (PEBA State Health Plan), Dental and Vision benefits
• Flexible Spending and Health Savings Accounts
• Voluntary Life Insurance
• Short Term Disability and Long Term Disability
• Optional contribution to a 403 (b) Retirement Plan, with up to 4% employer match after the first year of employment
• Continuing education courses through SC AHEC

Mission:

Our Mission is to provide quality, affordable, compassionate patient-centered health care to improve the health of the communities we serve. Our Vision is that our community will be one of the healthiest in the Nation. Superior patient care is the hallmark of NHFHS.

Community:

Greenville, South Carolina is the perfect place to live, work, and play. Greenville is surrounded by mountains, lakes, hiking & biking trails, as well as recreational activities including golf, tennis, water sports, cultural performances and more. Geographically located between Atlanta, GA and Charlotte, NC, with beaches just 3.5 to 4 hours away.

We are an Equal Opportunity employer.