Clinical Quality Assurance Review Coordinator
Location: Nashville, Tennessee US
Job Number: 805
The Clinical Quality Assurance Review Coordinator coordinates, prepares, conducts clinical quality review audits, and reports findings of all providers within the Care Group. This position acts as a valued resource in the audit process, working closely with DentaQuest's Care Group practice managers, providers, operations and quality Team. The Clinical Quality Assurance Review Specialist provides assistance to the Director, Clinical Quality Assurance in identifying and recommending process improvements based on audit findings. This position has no direct reports.
PRIMARY JOB RESPONSIBILITIES:
- Conduct audits on all Care Group centers based on Care Group policies and procedures, state, and federal regulations. Focusing on quality of care, over or under utilization of services, proper billing of completed treatment, ensure that preventative services have been complete.
- Update DentaQuest's Management staff regularly on status of audits.
- Accountable for understanding state requirements as they relate to compliance and billing. Specifically, The Care Group states Medicaid office reference manual and each states' dental laws at a minimum.
- Prepare existing audit tool and communication for Care Group centers and providers.
- Select statistically valid random samples of patients to conduct audits using Power BI software.
- Identify changes needed due to audit deficiencies and coordinate with appropriate departments to ensure they are implemented
- Track centers and/or providers performance improvement plans via a spreadsheet.
- Conduct re-audits as needed based on audit findings
- Perform miscellaneous tasks and assist with projects as assigned by the Director, Clinical Quality Assurance.
- Communicate audit results to appropriate management, centers, and providers as required.
- Meet management's expectations for submission of reports, within determined timeframes.
- Cultivate and maintain professional relationships with all DentaQuest's Care Group departments.
- Represent DentaQuest in a professional manner at all times
- Other duties as assigned.
- High school diploma or G.E.D.
- 3 years' experience in related healthcare field is required.
- Ability to read, interpret and analyze x-rays
- Knowledge of clinical and industry terminology and procedures.
- Ability to effectively work with Practice Managers and providers, as well as internal departments as required to accomplish each task.
- Strong time management, organizational, and prioritization skills required.
- Ability to manage multiple tasks.
- Self-motivated, and ability to work with little supervision and make independent decisions.
- Strong written/oral communication and analytical skills.
- Required to attend additional training as requested/deemed necessary.
- Registered Dental Hygienist or Dental Assistant preferred
- Knowledge of computer software (Excel, Word, Access a plus)
- Incumbent must be able to communicate effectively.
- Requires overall light physical effort (up to 25lbs.)
- Manual dexterity and sitting is required in carrying out position and position responsibilities (i.e. use of personal computer).
- Ability to travel or move about within and outside serviced facilities required.
- Incumbent works primarily in either a private or shared office environment.
At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system - from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and deliveringmeasurableoutcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
Job Number: 2613
Community / Marketing Title: Clinical Quality Assurance Review Coordinator
Location_formattedLocationLong: Nashville, Tennessee US