Quality Reviewer

POSITION SUMMARY

 The Quality Reviewer is responsible for overseeing quality reporting processes to payers, including in-office assessments (IOAs). This position involves attending regular meetings with payers to review data and identify opportunities for improvement. Responsibilities include collecting and analyzing health data to identify trends and gaps in care, ensuring compliance with regulations such as HEDIS and CMS guidelines, and providing feedback to healthcare practices to enhance quality outcomes. Additionally, the role involves tracking performance by chart auditing clinical staff, metrics related to population health initiatives and reporting findings to leadership.

 

This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation.

 

QUALIFICATIONS

EDUCATION: High school diploma or equivalent, minimum 3 years’ experience required within an ambulatory care setting required, certified Medical Assistant preferred

 

 

LICENSE/CERTIFICATION: Valid driver’s license required.

 

EXPERIENCE: Minimum 3 years of experience required within an ambulatory care setting required. 

 

PERFORMANCE EXPECTATIONS

Demonstrates the competencies as listed on the Assessment and Evaluation Tool.

 

WORK ENVIRONMENT

Essential functions of this position are listed on the Assessment and Evaluation Tool

REPORTING RELATIONSHIP

This position reports to department leadership.

The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

 

Total Rewards at AtlantiCare

At AtlantiCare, we believe in supporting the whole person. Our market-competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well-being of our team members. We offer a comprehensive suite of benefits and resources, including:

Generous Paid Time Off (PTO)

Medical, Prescription Drug, Dental & Vision Insurance

Retirement Plans with employer contributions

Short-Term & Long-Term Disability Coverage

Life & Accidental Death & Dismemberment Insurance

Tuition Reimbursement to support your educational goals

Flexible Spending Accounts (FSAs) for healthcare and dependent care

Wellness Programs to help you thrive

Voluntary Benefits, including Pet Insurance and more

Benefits offerings may vary based on position and are subject to eligibility requirements.

Join a team that values your well-being and invests in your future.