What are the responsibilities and job description for the Quality Specialist position at Medical Associates Plus?
SUMMARY DESCRIPTION:
The Quality Specialist abstracts clinical documentation and assigns proper ICD-10 codes at designated time points according to coding convention and payer-specific limited coverage guidelines. Interprets clinical documentation, including documentation from referral documents, EMR systems and other relevant sources. Position provides guidance and acts as resource to intake, quality improvement, clinical leadership and clinical staff in the correct use of ICD-10 codes, as required.
MAJOR AREAS OF RESPONSIBILITY
1. Holds self and team members accountable for knowledge of and full compliance with customer service performance standards as listed on all team members job descriptions.
2. Supports Performance Improvement and Patient Safety activities.
3. Works collaboratively with physicians, physician extenders, nurse, case manager and medical records coding team to identify opportunities to clarify documentation in patient records.
4. Queries the medical staff to obtain accurate and complete physician documentation that supports severity of illness (SOI), risk of mortality (ROM) and reimbursement.
5. Makes sure that patient information is kept confidential.
6. Recognizes that patient safety and performance improvement are priorities by striving to continuously improve service excellence, clinical excellence, improve performance and patient safety, quality outcomes, teamwork, patient care coordination, and resource management.
7. Complies with Neighborhood Improvement Project, Inc. policies and all applicable regulatory standards, including JCAHO, OSHA, Medicare, etc.
8. Assures only authorized personnel attain access to patient care records and maintains confidentiality.
9. Attends mandatory educational coding classes.
10. Demonstrates knowledge of and facility in use of the electronic record system.
11. Performs all other assigned duties within scope of knowledge.
EDUCATION:
High School Graduate. College degree preferred; formal medical office assisting training preferred.
EXPERIENCE:
- Excellent oral and written command of English.
- Previous experience in medic gang coding in a multi-specialty health care environment strongly preferred.
- Ability to demonstrate professionalism in a demanding, high stress and fast-paced environment.
- Demonstrated understanding of cultural issues related to health care.
- Must be sensitive and knowledgeable of the distinction between neutral interpreting and patient advocacy. Must pass an oral and written competency exam.
- Basic computer skills required, i.e. Microsoft Office.
- Must be flexible and able to prioritize multiple tasks.
PHYSICAL DEMANDS:
Must be able to perform duties with reasonable accommodation. May require the ability to sit and concentrate for long periods of time to perform sate entry. May require bending, stooping, lifting and working in a compact area. Seeing and reading are required.
TYPICAL WORKING CONDITIONS:
Work is performed in a high function office environment. Interaction with others is constant and interruptive. Contact involves dealing with patients with vast illnesses. Occasional evening work.
Medical Associates Plus reserves the right to direct its workforce, this includes but is not limited to work location, work hours and job duties.
QUALIFICATIONS
EDUCATION: High School Graduate. College degree preferred; formal medical office assisting training preferred.
LICENSE/CERTIFICATION: N/A
EXPERIENCE:
- Excellent oral and written command of English.
- Previous experience in medic gang coding in a multi-specialty health care environment strongly preferred.
- Ability to demonstrate professionalism in a demanding, high stress and fast-paced environment.
- Demonstrated understanding of cultural issues related to health care.
- Must be sensitive and knowledgeable of the distinction between neutral interpreting and patient advocacy. Must pass an oral and written competency exam.
- Basic computer skills required, i.e. Microsoft Office.
- Must be flexible and able to prioritize multiple tasks.
PHYSICAL DEMANDS
Must be able to perform duties with reasonable accommodation. May require the ability to sit and concentrate for long periods of time to perform sate entry. May require bending, stooping, lifting and working in a compact area. Seeing and reading are required.
TYPICAL WORKING CONDITIONS
Work is performed in a high function office environment. Interaction with others is constant and interruptive. Contact involves dealing with patients with vast illnesses. Occasional evening work.
Medical Associates Plus reserves the right to direct its workforce this includes but is not limited to work location, work hours and job duties.
