Job Opening for Clinical Quality Management Analyst 1954 in ASC (Remote)

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Job Category : Management
Company Name: ASC
Position Name: Clinical Quality Management Analyst 1954
Location : Remote
Job Description : Two Senior levels Clinical Quality Management Analysts are needed for this position.This job works with appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for all product lines. Recommends and implements process improvements related to the potential of quality medical care and service to members and to improve documentation of these services for appropriate ICD 10-CM coding. Serves as a resource and educator regarding provider and office staff medical record documentation, federal and state standards including CMS and NCQA standards, and continuous quality improvement principles. Perform special studies per audits, conducting office site visits and medical records reviews, ensuring improvement in performance for various initiatives in a timely manner. May coordinate credentialing, re-credentialing, member complaint investigations, Medical Director site visit requests, facility site visit requests, activities to include other reviews, audits, accreditation activities as requested on behalf of the organization.Responsibilities: This job works with appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for all product linesRecommends and implements process improvements related to the potential of quality medical care and service to members and to improve documentation of these services for appropriate ICD 10-CM codingServes as a resource and educator regarding provider and office staff medical record documentation, federal and state standards including CMS and NCQA standards and continuous quality improvement principlesPerform special studies per audits, conducting office site visits and medical records reviews, ensuring improvement in performance for various initiatives in a timely mannerMay coordinate credentialing, re-credentialing, member complaint investigations, Medical Director site visit requests, facility site visit requests, activities to include other reviews, audits, accreditation activities as requested on behalf of the organizationDevelop and manage process improvement initiatives from the Organization for member and providers to include detailed data analysis, process analysis, report generation, medical record documentation, and HCC CodingConduct, collect and analyze information and data from office site and/or medical record reviews to continually improve the care, services, proper documentation and coding for members, to properly assign ICD10-CM codes to chronic conditions, and coordination with the revenue programs, credentialing and quality improvement programs to improve STARS, value based care and achieve and maintain accreditationMonitor changes, corrections and clarifications in applicable regulatory/accrediting body requirements and make adjustments to the compliance plan and to follow CMS Coding GuidelinesConduct retrospective, concurrent, and prospective, semi-annual and annual audits, identify gaps and communicate resultsConduct continuing education to providers on STARS, HEDIS, and HCC CodingConduct re-audits as neededOther duties as assigned or requestedQualifications: Current state RN or LPN license or Bachelor’s degree in a Healthcare-related fieldMust have ambulatory coding experienceBackground within coding or as a clinician6+ years of progressive medical coding experienceMust have extensive knowledge in medical coding3-5 years of relevant, progressive experience in the area of specializationCPC, CRC, RHIA, or CCS Certification preferredAn understanding of Total Quality Management (TQM) concepts, techniques, process and outcome measurements ( 1-2 years)An understanding of statistics is also preferred in order to analyze various reports and validate study methodologies (1-2 years)Excellent verbal communication skills and professional manner, excellent written communication skills and a familiarity with a variety of writing stylesMust be able to communicate with medical administrators, including Medical Directors and Physician Advisors related to problem identification, action plan implementation, ongoing monitoring, and problem resolutionDemonstrated computer literacy and knowledge of information systems and comparative databasesWorking knowledge of Microsoft Office software (Word, Excel, Access, PowerPoint, etc.) (1-3 years)Well-developed, analytical, and problem-solving skills with the ability to understand and interpret clinical dataPrior project management experience preferred (1-3 years)Must be willing to go the extra mileExperience with Burgess preferredJob Type: Full-timePay: $42.00 per hourBenefits:Dental insuranceHealth insuranceVision insuranceSchedule:Day shiftCOVID-19 considerations:**Please note that, pursuant to the Company’s COVID-19 mitigation protocols, individuals must be fully vaccinated upon starting employment, subject to legally required exemptions.**Application Question(s):How many years of progressive medical coding experience do you have?Do you have CPC, CRC, RHIA, or CCS Certifications?Do you have prior project management experience?Do you have ambulatory coding experience? This is a must for the position. If yes, please indicate the position(s) and company(s) where you gained this experience.Work Location: Remote
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