Access Health Care is seeking an experienced Clinical Quality & Documentation Improvement Specialist to join the Quality Department. This role is designed for a clinically licensed professional with a strong interest in quality improvement, value-based care, population health, risk adjustment, and provider education.
The position focuses on monitoring, auditing, and improving clinical documentation, coding accuracy, quality outcomes, utilization management, and regulatory compliance. The specialist works closely with providers and office staff to support quality measures, close care gaps, improve patient outcomes, and optimize organizational performance.
Key responsibilities include auditing medical record documentation for NCQA and CMS compliance, supporting HEDIS, CMS Star Ratings, ACO measures, and value-based care initiatives, reviewing quality gap reports, conducting documentation and coding audits, educating providers and staff, assisting with Medicare Risk Adjustment initiatives, analyzing quality and utilization data, collaborating with care management teams, and serving as a subject matter expert for quality and documentation improvement efforts.
Current Florida RN or LPN license.
At least 3 years of clinical healthcare experience.
At least 2 years of experience in one or more of the following:
- Quality Management
- HEDIS
- Medicare Advantage
- Risk Adjustment
- Clinical Documentation Improvement (CDI)
- Utilization Management
- Population Health
- Care Management
- Medical Coding Compliance
Working knowledge of:
- NCQA Standards
- CMS Guidelines
- HEDIS Measures
- CMS 5-Star Programs
- ACO Quality Measures
- Medicare Advantage Programs
- Risk Adjustment Methodology
- Clinical Documentation Improvement Practices
- ICD-10 and CPT coding guidelines
Strong ability to review and analyze medical records. Excellent verbal and written communication skills. Strong organizational and time-management skills. Ability to educate and engage providers and clinical staff. Proficiency with EMR/EHR systems and Microsoft Office. Ability to travel between assigned practice locations as needed.
Preferred certifications include CPC, CRC, CCDS, CDIP, CPHQ, or CCM. Candidates without certification must be willing to obtain a CPC, CRC, CCDS, or CDIP within 12 months of hire.
Competitive salary
Comprehensive benefits package including:
- 401(k)
- 401(k) matching
- AD&D insurance
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Prescription drug insurance
- Referral program
- Retirement plan
- Vision insurance
Professional growth and development opportunities. Collaborative team environment. Meaningful impact on patient outcomes and quality performance.
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 week ago