QA Coordinator

Summary: Compile, scan, process, and maintain medical records for enrollees and participants in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements. Prepares charts for new enrollees. Maintains logs, sends for and releases medical information, compiles assessment and treatment summaries, files, copies, and faxes medical information. Ensures accurate and timely entry of data into various databases, logs, etc.: generates needed reports. Ensures transmission of required data to governmental entities

 

Essential Functions 

Processes and maintains all electronic and paper participant records including and not limited to enrollment and disenrollment, medical and social histories and IDT encounters and provide data for reporting and quality assessment.

Files documents into active records.

Keeps face sheet and other required information up to date.

Protects the security of medical records to ensure that confidentiality is maintained.

Reviews records for completeness, accuracy and compliance with regulations.

Maintains hard copy and electronic filing system as required.

Sends for medical information for applicants and participants at time of intake and as requested by Interdisciplinary Team (IDT).

Releases information to persons and agencies according to ArchCare Senior Life policies and procedures, and in according with compliance with HIPAA and other regulatory requirements. Maintains logs as required by HIPAA.

Resolves/clarifies codes and diagnoses with conflicting, missing, or unclear information by consulting with medical staff or others to get additional information.

Coordinates and disseminates agenda for IDT meetings. Maintains tickler files to ensure timely assessment/reassessment of enrollees. Attends IDT meetings, compiles assessment and treatment summaries, meeting records, etc. Updates care/treatment plans and obtains required signatures.

Conducts routine monthly and ad hoc medical record audits.

Compiles and enters demographic, utilization, assessment and other data into other databases and systems as required. Checks accuracy of entered data for file creation and upload as appropriate.

Prepares charts/EMR for surveys by regulatory agencies and other program needs as required.

Purges records and files documents into closed charts. Thins charts according to established protocols.

Maintains medical record forms inventory; reorders and restocks as needed.

Maintains flexibility in schedule and responds to unexpected emergencies and changes in workload in order to fulfill responsibilities

Meet a standardized set of competencies for the specific position description established by the PACE organization and approved by CMS before working independently

 

 

Requirements

 

Min 1 year of Medical Records or Data Entry Experience.

Working knowledge of healthcare industry terminology and ICD-9 codes. Specifically with regards to medical/clinical documentation, Physician or other provider coding or billing and or Medicare and Medicaid regulations.