Quality Assurance Specialist

$15.00 - $17.00 hourly
  • Silver Pine Medical Group
  • 53950 Van Dyke Ave, Shelby Township, MI 48316
  • Sep 16, 2022
Full time Admin-Clerical Health Care

Job Description


The Quality Assurance Specialist supports the development of patient-centered, team-based care. S/he will support primary care physicians (PCPs) and practices in managing their panel of patients. By organizing patient data, the Quality Assurance Specialist works to capture patients’ unmet needs, engage patients in their own care, gather summary information for treatment interventions, and enhance ongoing communication between the patient and her/his care team. The Quality Assurance Specialist is responsible for supporting quality improvement efforts as defined by the various health insurance companies and patient population. The Quality Assurance Specialist will serve as a facilitator and catalyst for improving the clinical and operational performance using the Patient Centered Medical Home (PCMH) model of care within the practice. Clinical duties may include recording/updating medical record documentation and medical histories. Preparing patients for specific screenings based on chronic conditions and preventative health maintenance requirements. Ordering specific screenings and tests based on patient health and as recommended by physician champions.

Job Duties

· Develops a keen understanding of primary care practice requirements for optimal, coordinated population health

· Contributes to quality improvement and care redesign of population health efforts

· Review patient’s medical charts for required services and quality opportunities

· Enter required date of service data into various health plan databases

· Contact patients regarding needed services and clearly communicate the importance of various services

· Collaborate with care teams to establish population-appropriate, pre-visit, and point of care processes

· Perform outreach functions, as necessary, to patients identified as having chronic conditions for needed services

· Review reports as generated by the various insurance companies for areas of opportunity and improvement

· Monitor and correct patient attribution to the practice and the care teams within the practice

· Support practice staff to develop creative processes to proactively manage target populations

· Provide data integrity, coordination, and patient outreach as needed for specific target patient populations

· Contributes to a positive experience for patients and families through courteous telephone interactions as well as referral to appropriate clinical staff when necessary

· Answer and/or research questions on problems the clinicians have identified

· Recognize and report data inconsistencies to appropriate personnel

· Contributes to the teamwork within and between departments. Regularly attends and participates in meetings with coworkers and practice staff. Provides constructive ideas, suggestions and feedback in a positive manner. Works collaboratively with co-workers to effectively resolve issues that impact departmental or hospital operations

· Perform all job functions in compliance with applicable federal, state, local and company policies and procedures

· And other duties as assigned

Qualifications and Education

· High School Graduate or GED

· Medical Assistant Certificate preferred

· Minimum two years’ experience in a healthcare setting

· Strong knowledge of existing Healthcare Effectiveness Data and Information Set (HEDIS) and quality measures preferred

· Strong knowledge of medical terminology

· Demonstrated computer skills for documenting patient care services in a health plan database

· Ability to communicate effectively in person, on the telephone, and in writing

· Ability to work independently and as a team

· Strong ability to multitask in a busy primary care office setting

· Ability to read and comprehend patient medical charts and medical terminology