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.
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.
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.
...DescriptionWELD is seeking a junior quantitative and/or qualitative researcher (Step 1/ Research track) to work on a range of education and... ...generous paid time off, including nine federal holidays, medical (including prescription), dental and vision insurance, and transit...
...Job Overview TLC Nursing Associates, Inc. is seeking a Medical Social Worker for travel assignments in healthcare settings such as hospitals, rehabilitation centers, and long-term care facilities. The Medical Social Worker will assist patients and their families...
...Position Details Posted: May 29, 2026 Level: Educational Assistant Employment Type: Temporary position, non-tenure track position... ...events which do have a technical staff. Assisting in pre-production planning and organizing including: consultation with...
...-being of our communities as a leader in clinical laboratory solutions. Location: Wailuku, HI Status: Full... ...On/Relocation Bonus may be available." In this Medical Laboratory Scientist/Medical Laboratory Technician role, you will: Perform routine and complex analytical...
...and off-site events as needed. o Social media experience is a bonus. We love team members who enjoy helping tell our story by assisting in content creation. o Creative thinkers who enjoy contributing ideas for customer experiences, marketing initiatives, and brand...