The role of the Quality Assurance Coordinator (QA Coordinator) is to monitor and audit medical record documentation, coding and quality measures for compliance and accuracy. It is critical for the QA Coordinator to have knowledge of 5 STAR, PQRS, HEDIS, CMS coding guidelines, and coding/documentation and billing standards and regulations.
The QA Coordinator uses their knowledge of ICD-9/ICD-10, CPT, and documentation guidelines as well as billing knowledge to assist in any and all coding and documentation audits and/or billing functions as determined by the Compliance, Operations, and/or Quality department(s). Additionally, the QA Coordinator participates in company-wide quality initiatives.
Key Duties & Responsibilities:
- The QA Coordinator is responsible for providing support for quality assessment and performance improvement activities that include quality monitoring, evaluation and facilitation of performance improvement projects.
- Follows most recent documentation and coding guidelines
- Uses only pre-approved source documents as validation for recommendations on documentation that meets the technical specifications in support of a measure
- Assists with all quality measures initiatives – working with the PCP offices in capturing the data to support the variables.
- Works all Gap reports for 5 STAR and assists with the ACO GPRO quality measures projects as they become relevant and assists with all quality initiatives as needed.
- Process and manage member and provider communications as appropriate to each project.
- Assists in teaching any office staff and/or providers in proper documentation and coding guidelines as necessary
- Reports any issues to Quality, Compliance and Operations as necessary.
- Responds to inquiries regarding this area of expertise.
- Accurately enters all identified and validated measures into the practice’s EMR – if necessary to aid the CCDIs, may enter validated conditions as indicated by the CCDIs into the EMR
- Assists in all RAPS submission projects as they occur if needed in back-up to the CCDIs
- Assist in the preparation of quality and safety data reports for committees and meetings.
- Prepare meeting materials and create meeting quality improvement minutes when warranted
- Performs Quality education to providers/staff.
- Performs all other coding and documentation reviews and/or projects as asked and assists/coordinates strategies as defined by the department head or assistant.
Required Skills/Abilities:
- Excellent verbal and written communication skills.
- Excellent organizational skills and attention to detail.
- Excellent time management skills with a proven ability to meet deadlines.
- Proficient with Microsoft Office Suite (Word and Excel) or related software.
- Communication / Coordinate sharing of pertaining information accurately.
- Critical Thinking / Problem solving/Computer
- Has proficient knowledge and experience working with an EHR system.
- Ability to travel.
- Ability to read and analyze medical records.
- Knowledge and understanding of ICD -9/10 , CPT codes and QIP measures – CPC or CSSP is a plus
- Understands documentation, coding and billing guidelines as well as how to read the technical specifications on all quality initiatives.
Supervisor Responsibilities:
- None.
Education and Experience:
- Prefer candidate to have some medical record or quality background and current ICD-9/10 coding education.
- 1-2 years of documentation or medical records experience in any part of the medical continuum.
- Must demonstrate the ability to utilize Excel and WORD via assessment at interview.
Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer.
- While performing the duties of this job the employee is regularly required to sit, use hands and arms, talk and hear.
- Must be able to lift up to 10 pounds at times.
Benefits:
- Health insurance
- Dental Insurance
- Vision insurance
- Life insurance
- 401(k)
- Paid time off
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Job Type: Hybrid
Palm Primary Care is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm Primary Care makes hiring decisions based solely on qualifications, merit, and business needs at the time.
Skills Required
- Knowledge of ICD-9 and ICD-10 coding
- Knowledge of CPT coding
- Familiarity with 5 STAR, PQRS, HEDIS and CMS coding guidelines
- Proficient with Microsoft Word and Excel (ability to demonstrate in interview)
- Proficient knowledge and experience working with an EHR/EMR system
- Ability to read and analyze medical records
- Understanding of documentation, coding and billing guidelines and quality initiative technical specifications
- 1-2 years of documentation or medical records experience
- Excellent verbal and written communication skills
- Strong organizational and time management skills with attention to detail
- Ability to travel
- Familiarity with QIP measures and gap report processes (e.g., working gap reports for 5 STAR, ACO GPRO)
- Current ICD-9/10 coding education or medical records/quality background
- CPC or CSSP certification
What We Do
Palm Medical Centers is a rapidly growing senior primary care leader and Medicare medical practice dedicated to providing high-quality, personalized, value-based healthcare for seniors and adults. Operating over 30 centers throughout Florida and expanding into Texas, they focus on delivering an elevated level of primary care services to ensure patient safety and improve outcomes for the aging population they serve.
