Description

AtlantiCare Regional Medical Center

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.


Description

ATLANTICARE HEALTH SYSTEM

ROLE DESCRIPTION

TITLE: LIFE Connection Quality Analyst

JOB CODE: #2912

EXEMPT:

NON-EXEMPT: X

DATE: 10/21

REVISED: 01/26 (PS, Q)

Minimum Qualifications:

• Bachelor's degree required with 5 years job related field experience.
• Proficiency in Microsoft Suite with strong focus on Microsoft Excel
• EMR proficiency (Cerner, PACE Logic, or equivalent).
• 5 years' experience in medical records coordination, compliance, or quality oversight (PACE/LTC/Home Care Preferred)
• Must possess a comprehensive understanding of CMS regulations, HIPAA Privacy & Security Rules, and documentation standards.
• Must possess strong analytical & organizational skills, with attention to regulatory detail.

POSITION SUMMARY

The Quality Analyst serves to strengthen regulatory compliance, quality performance, participant safety and data integrity within the PACE program. This position will serve as a key liaison between interdisciplinary teams, external providers and regulatory bodies to ensure medical records are complete, timely, and compliant with state & CMS standards. The Quality Analyst will act as the bridge between Health Information Management (HIM) operations and Compliance oversight, ensuring participant data integrity, HIPAA adherence, and regulatory readiness through proactive monitoring, organizational audits, and interdepartmental coordination & education. This role supports compliance with CMS 460.60, PACE documentation standards, and AtlantiCare's Quality and Compliance program goals.

In collaboration with the LIFE Connection quality/compliance team, this role has the following responsibilities:

• Interpret and apply CMS, HIPAA, and NJ DOH regulations to participant record management, retention, and access.
• Develop, maintain, and implement policies and procedures for medical record documentation and compliance activities.
• Perform internal audits of participant medical records, tracking timeliness, completeness, accuracy, and regulatory compliance.
• Conduct comprehensive chart reviews to identify all clinically relevant, CMS -acceptable diagnosis for HCC capture.
• Collaborate with finance, quality and clinical departments to ensure HCC coding accuracy based upon CMS Risk Adjustment Guidelines.
• Stay current with annual HCC model changes, ICD-10 updates, CMS Memos, NPA Guidance and Audit trends.
• Serve as the primary compliance liaison for all HIM-related activities, supporting audits, process improvements and surveys.
• Coordinate secure data exchange with hospitals and contracted facilities through HIE or direct methods to ensure record exchange compliance and interdisciplinary documentation consistency.
• Ensure consistency between care plans, MARs, and progress notes through regular reconciliation.
• Develop compliance and HIPAA training materials for staff; lead education sessions on documentation best practices.
• Educate providers on risk-adjusted documentation standards, specificity requirements, and annual condition re-assessment rules.
• Assist with investigation and reporting of privacy breaches, documenting corrective actions per CMS and HIPAA standards.
• Support implementation and optimization of EHR systems (Cerner, PACE Logic) to enhance data accuracy, efficiency and compliance tracking.
• Generate data dashboards and reports on audit trends, compliance metrics, and corrective action outcomes for QA Committee review.
• Provide data abstraction for QAPI indicators and trend analysis for quality performance improvement and reporting.
• Assist with the creation & monitoring of PDCAs in place for quality & process improvement.
• Monitor & mediate corrective action plans & immediate corrective action plans that were developed from regulatory deficiencies & CMS Audits.

The Quality Analyst maintains expertise in applications, systems and services related to the electronic health record and other monitoring/tracking & reporting databases.

The Quality Analyst position supports organizational goals by:

• Strengthens survey readiness and regulatory compliance.
• Reduces audit findings and documentation deficiencies within the EMR.
• Improves timeliness of care coordination, data submissions, and resolution of HIPPA/regulatory incidents.
• Improves risk-adjustment, HCC, and ICD-10 coding accuracy.
• Enhances communication and data exchange between PACE and contracted facilities, per CMS regulations.
• Supports data validation accuracy prior to HPMS reporting, minimizing compliance risk.
• Supports tracking, trending, and reporting quality improvement initiatives.
• Standardization of processes to improve efficiency, accuracy & alignment with state, CMS & NPA quality expectations.
• Strengthen interdisciplinary coordination through ongoing education to improve participant safety & quality of care.

QUALIFICATIONS

EDUCATION: Bachelor's degree with 5 years related job related field experience.

LICENSE/CERTIFICATION: N/A

EXPERIENCE: 5 years' experience in Medical Records Coordination, Health Information Management, Compliance, or Quality Assurance within the healthcare setting (PACE/LTC/Home Care preferred). Proficiency in Microsoft Suite with strong focus on Microsoft Excel, and Electronic Health Record platforms (Cerner, PACE Logic, or equivalent). Must possess a strong understanding of CMS PACE regulations, HIPAA Privacy & Security Rules, data governance principles and documentation standards. Must possess strong analytical & organizational skills, with attention to detail.

WORK ENVIRONMENT

Potential for some exposure to the hazards and risk of (the healthcare environment), including exposure to infectious disease, hazardous substances, and potential injury. Works with such equipment as computer terminal, fax machine, copier, and telephone. This position requires some walking and standing and may have prolonged periods of sitting.

The essential functions for this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP

This position reports to department leadership.

AtlantiCare Total Rewards

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.


Job Category
Administrative / Customer Service

Hours Per Week
37.5

Weekends Required?
No

Holidays Required?
No

Shift
Days

Posititon Status
Full-Time


Job Details

Pay Range
$22.38 - $33.57

Pay Transparency

In order to support the Fair Compensation Strategy by the US Govt., HR Dept., clients are required to adhere to Pay Transparency Law; in the impacted states; that have mandated the employers to list the salary ranges in Job advertisements or postings for job opportunities and Job promotions.

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