Job Description

Key Responsibilities

• Process Auditing & Record Review: Conduct routine, structured audits of patient case files, member records, and documentation to verify accuracy, completeness, and compliance with institutional standards.

• Data Collection & Entry: Accurately extract, compile, and maintain data from various health information systems to support quality scorecards and performance monitoring.

• Regulatory Compliance Support: Assist in gathering documentation and prepping audit trails for scheduled state and federal reviews (CMS, DOH, NCQA HEDIS).

• Trend Identification: Help monitor operational workflows and flag inconsistencies, documentation gaps, or deviations from established protocols to senior QA team members.

• Reporting & Tracking: Maintain internal tracking logs, compile compliance spreadsheets, and assist in drafting basic data summary reports for quality improvement committees.

• Cross-Functional Collaboration: Partner with clinical, customer service, and care management teams to clarify documentation inaccuracies and support corrective action plans.

Required Qualifications

• Education: Bachelor’s degree in Healthcare Administration, Public Health, Health Information Management, Business Administration, or a related field.

• Experience: 0–2 years of experience in an administrative, analytical, or auditing role. Experience or internships within a healthcare or health insurance setting are highly preferred.

• Core Skills:

  • Exceptional attention to detail and strong organizational skills.

  • Intermediate proficiency with Microsoft Office Suite (particularly Excel functions like filtering, sorting, and basic data entry formatting).

  • Ability to handle highly sensitive, confidential patient information with strict adherence to HIPAA guidelines.

• Communication: Strong written and verbal communication skills; comfortable reaching out to internal teams to gather or clarify data.

Preferred Qualifications

• Familiarity with healthcare quality improvement frameworks (e.g., PDSA cycles, Lean concepts).

• Basic understanding of Medicaid/Medicare plan structures, HEDIS metrics, or clinical documentation standards.

• Comfort learning new electronic health records (EHR) and database management software.

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