Quality Specialist

Job Responsibilities: Reviews and facilitates modifications to clinical documentation through concurrent (pre-bill) interaction with providers and other members of the healthcare team. Promotes capture of clinical severity to coded data by HIM team that supports the inpatient rehabilitation levels of service and complexity. Communicates with the interdisciplinary team either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting health record documentation, and clarifies the information as warranted. Educates providers about identification of disease processes that reflect complexity and acuity in order to facilitate accurate application of code sets. Demonstrates an understanding of complications, comorbidities tiers, RICs, IGC, case mix group on the billed record, as well as the ability to impart this knowledge to providers and other members of the healthcare team. Gathers and analyzes information pertinent to documentation findings and outcomes, and uses this information to develop action plans for process improvements. Analyzes quality trends and collaboratively creates action plans for performance improvement surrounding acute care transfers/hospital readmissions with consideration at the hospital, unit and patient specific trend levels. Patient safety indicators including falls, healthcare associated pressure injuries, infections Functional improvement outcomes Other quality measures as identified or regulated Provides analysis and guidance for improving and maintaining quality components for USNWR/Newsweek publicly reported metrics to achieve best in class rankings. Assists with the annual AHRQ Survey of Patient Safety Culture process and facilitates results review, reporting and action planning with leadership for improved performance. Identifies performance improvement opportunities and develops processes, procedures, and policy to support these initiatives. Evaluates workflow processes utilizing lean strategies, process mapping, and performance improvement principles to identify opportunities and efficiencies.