Job description:
Position Summary
We are seeking a detail-oriented Clinical Documentation & Quality Assurance Specialist with strong medical knowledge and experience within the U.S. healthcare system. This role is responsible for reviewing, interpreting, and validating clinical documentation and progress notes to ensure accuracy, compliance, continuity of care, and alignment with insurance and quality measure requirements.
The ideal candidate must be able to identify documentation gaps, support audit prevention initiatives, and work collaboratively with clinical and operational teams to improve overall documentation quality and patient care workflows.
Key Responsibilities
- Review and interpret clinical progress notes for accuracy, completeness, and consistency.
- Identify discrepancies, missing documentation, or potential compliance concerns.
- Ensure documentation supports continuity of care measures and quality initiatives.
- Review encounters to confirm alignment between diagnosis, treatment plans, referrals, orders, and follow-up care.
- Support prevention of insurance audits by identifying risk areas proactively.
- Verify that documentation supports billing, coding, medical necessity, and payer requirements.
- Monitor quality measures (HEDIS/QCM/Preventive Care metrics) and ensure proper clinical documentation.
- Communicate documentation concerns and recommendations to providers and operational leadership.
- Assist in workflow optimization related to patient care documentation and compliance.
- Maintain knowledge of HIPAA regulations and documentation standards.
- Participate in internal quality improvement initiatives and chart audits.
Qualifications
- Strong medical terminology and clinical documentation knowledge required.
- Experience reviewing and interpreting progress notes and patient charts.
- Understanding of continuity of care measures, preventive care workflows, and quality metrics.
- Knowledge of insurance audit prevention and documentation compliance standards.
- Familiarity with HEDIS, quality measures, risk adjustment, or value-based care preferred.
- Experience within the U.S. healthcare system strongly preferred.
- Experience with EMR/EHR systems (preferably eClinicalWorks/eCW) preferred.
- Advanced English level required (written and verbal communication).
- Strong analytical skills and attention to detail.
- Ability to work independently and manage sensitive/confidential information appropriately.
- Excellent written and verbal communication skills.
Preferred Background
- Medical Assistant, Nurse, Quality Assurance, Clinical Documentation, or Healthcare Administration background preferred.
- Previous experience in primary care, managed care, or quality management environments is highly desirable.
Benefits:
- Health insurance
- On-site parking
- Paid training
- Promotion to permanent employee
