Quality Specialist

Position Summary :

The Data Quality Specialist monitors and coordinates activities that relate to maintaining the quality and integrity of the medical records.

This involves reviewing the medical record for accuracy, completeness and regulatory compliance on an ongoing basis. This position actively interfaces with Nursing, Compliance / Risk Management, Quality and clinicians when issues are identified.

Essential Duties and Responsibilities :

Maintains current knowledge of regulatory requirements for requirements for record content, completion, privacy and quality standards.

Facilitates the dissemination of the information to the Vice President and / or Director of Quality and other appropriate personnel when notifications of changes to regulations are identified.

• Stay current on reporting requirements and changes to national and local guidelines and performance targets.
• Reviews data sets as they pertain to Value Based Purchasing, hospital Inpatient Quality Reporting, Hospital Readmission Rates and other major quality reports from CMS QualityNet, Comp data, CDC, DNV, HFAP, IDPH, the Chicago Department of Public Health, Leapfrog and other reporting and oversight bodies.
• Effectively navigates through the electronic medical record system to establish routines and reports relating patient safety indicators, infection control, mortality and other data sets.
• Performs audits required by accrediting organizations to determine if the information in the medical records is meeting set standards and regulations.

Performs assigned Medicaid, Medicare, and other third-party payer audits when required.

Abstracts medical records for compliance with mandatory performance measures for CMS and The Joint Commission utilizing all applicable reporting tools and software.

Participates in implementation, concurrent review and abstraction for new measure sets.

• Extrapolates, analyzes and converts data into useful business intelligence using a variety of mediums and graphical displays.
• Maintains project documentation and ensures adherence to quality and compliance standards for project deliverables.
• Assists in data preparation for on-site surveys by regulatory agencies.
• Reviews / updates policies and procedures as directed by Director of Quality.
• Collaborates with information services or designee to abstract and analyze complex data / information requests.
• Ensures all timelines are met for abstraction and transmission of reports and data.
• Possess the ability to prepare and support Quality Improvement initiatives and projects.
• Works collaboratively with many disciplines and team members in auditing performance improvement for quality related to patient care and professional practices.

Qualifications :

• Minimum of 1 -2 years of related experience
• Associates’ degree or equivalent related experience is required
• Skill in the use of Microsoft Office, excel, and outlook applications.
• Knowledge and skill in electronic and paper medical record navigations
• Extensive knowledge and use of health care data reporting systems
16 days ago