The Quality Data Analyst position provides a vital link in the chain of healthcare revenue cycle reporting. The Quality Data Analyst is responsible for and performs review of clinical documentation to assess quality of patient care, identify areas of risk and opportunity for improved patient satisfaction based on MIPS, Quality Reporting, the ACO initiative and other required payer managed care quality reporting metrics. This position is also responsible for review, data mining and abstraction of clinical data for regulatory data submission and identification to include communication of trends and patterns in data that will facilitate quality improvement.
ESSENTIAL DUTIES AND RESPONSIBILITIES – Other duties may be assigned.
Performs initial clinical reviews for quality and risk metrics, composes clear and concise summary of pertinent information that will assist in determining need for further review or follow-up action.
Performs clinical review, data mining and abstraction, utilizing clinical knowledge and pre-established data requirements, of cases selected for mandatory and voluntary reporting requirements and performance improvement initiatives, to include meaningful use, PQRS, HEDIS and other required governmental payer and managed care reporting metrics.
Demonstrates proficiency and accuracy in clinical reviews and data reporting based on ongoing literature and measured by validation reports. Error correction is concise, accurate, and timely. Data input is documented in appropriate web-based tool and/or area designated by systems coordinator, Revenue Cycle Manager or Director.
Identifies and provides feedback on patterns or trends in data that will assist in facilitating improvement efforts. Makes appropriate referrals to management, and/or other quality team members to communicate issues identified.
Assists with data analysis and report preparation to track progress of mandatory and/or voluntary studies and identifies focus areas for performance improvement.
Keeps current on regulatory and accreditation requirements related to quality functions and specifications. Works to ensure current guidelines are being met for documentation of key quality measures. Functions as liaison to other team members and providers when specifications change or updates are required to data abstraction elements or process.
Works autonomously and possesses excellent problem solving skills, and is able to complete assigned duties within timeframe given.
Excellent communication and teamwork skills and is able to advocate for service excellence and clinical quality proficiency leading to positive results with quality initiatives.
Stays current on all CPT and ICD-10 changes/issues and insurance/contractual updates that affect reimbursement in order to keep physicians and providers informed.
Has working knowledge of electronic medical record system in order to review documentation, schedules, and determine levels of evaluation and management visits.
Audits revenue and payments on a daily basis.
Fields questions by physicians regarding codes, charges, payments, etc. Documents conversations and actions.
Associate Degree in Healthcare or related field with minimum 3 years related experience or Bachelor’s Degree in Healthcare or related field with minimum of 1 year related experience.
Medical coding in a physician group, hospital setting, or other medical setting preferred.
Comprehensive knowledge of medical, diagnostic, and procedural terminology required
Experience using PC applications such as MS Word, Excel, and PowerPoint
NCH Physician Group is a technologically advanced group medical practice utilizing Electronic Medical Records; the ability to utilize and understand a Windows-Based environment is essential.
Strong ability in clinical quality measurement and statistics.
Ability to read and interpret medical data.
Possess a strong attention to detail, a personal commitment to accuracy and excellent communication and interpersonal skills and demonstrated organizational skills.
Ability to work with and maintain confidentiality of physician, patient, patient accounts and personal data.
Capable of working under pressure in a fast-paced environment with frequent interruptions while maintaining a professional demeanor and control.
Willingness to be flexible depending upon department schedule needs.
Must be able to prioritize and work independently.
Good customer services and communication skills.