Quality Specialist

Job Summary

The Quality Specialist is responsible for abstracting clinical documentation and assigning accurate ICD-10 codes in accordance with current coding conventions and payer-specific limited coverage guidelines. This position interprets clinical documentation from referral sources, electronic medical records (EMR), and other relevant materials to ensure coding accuracy. The Quality Specialist provides guidance and serves as a resource to intake personnel, quality improvement teams, clinical leadership, and clinical staff regarding proper ICD-10 code utilization.

Medical Associates Plus (MAP) is a Federally Qualified Health Center (FQHC) located in South Augusta, Georgia. MAP has served Augusta and surrounding communities for more than 15 years, committed to providing high-quality, affordable healthcare.

Essential Duties and Responsibilities

1. Upholds and models MAP's customer service performance standards.
2. Supports performance improvement and patient safety initiatives.
3. Collaborates with physicians, advanced practice providers, nurses, case managers, and the coding team to clarify documentation in patient records.
4. Queries provide accurate and complete documentation supporting severity of illness (SOI), risk of mortality (ROM), and appropriate reimbursement.
5. Maintains strict confidentiality of all patient health information in accordance with HIPAA regulations.
6. Promote patient safety and service excellence through continuous improvement in clinical quality, outcomes, teamwork, and resource management.
7. Ensures compliance with all MAP policies and applicable regulatory standards (e.g., Joint Commission, OSHA, Medicare).
8. Verifies that only authorized personnel have access to patient care records.
9. Attends mandatory coding and documentation training sessions.
10. Demonstrates proficiency in the use of electronic medical record systems.

Education

• High school diploma or equivalent required.
• Associate or bachelor’s degree in health information management, healthcare administration, or a related field preferred.
• Formal training in medical office procedures or medical coding is preferred.

Licensure/Certification

• Certified Coding Associate (CCA), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) preferred but not required.

Experience

• Strong written and verbal communication skills.
• Previous experience with medical coding in a multi-specialty healthcare setting preferred.
• Ability to work professionally in high-pressure, fast-paced environments.
• Demonstrated cultural competence and sensitivity in healthcare settings.
• Knowledge of Microsoft Office and basic computer applications.
• Ability to prioritize tasks effectively and manage time well.

Physical Demands

• Must be able to perform essential duties with or without reasonable accommodation.
• May require extended periods of sitting and data entry.
• Occasional bending, stooping, lifting, and working in confined spaces.
• Visual acuity required for reading and data verification.

Working Conditions

• Work is performed in a professional office setting within a healthcare environment.
• Frequent interaction with staff and patients; interruptions are common.
• Exposure to individuals with a wide range of medical conditions.
• An occasional evening or extended hours may be required.

Additional Information

Medical Associates Plus reserves the right to assign or reassign duties and responsibilities to this position at any time. This includes but is not limited to changes in job location, work hours, and assigned tasks to meet organizational needs.