Clinical Quality Specialist

Job Summary

A company is looking for a Clinical Quality Specialist.

Key Responsibilities

• Evaluate technology-generated recommendations for clinical support and compliance
• Translate quality measures into actionable documentation and coding rules
• Collaborate with cross-functional teams to optimize quality measure support and validate model outputs

Required Qualifications

• Medical degree (RN or similar clinical background)
• Experience in Inpatient Quality Reporting or Coding for Value-Based Care
• Deep knowledge of clinical quality programs including MIPS, HEDIS, and Star Ratings
• Strong understanding of ICD-10-CM, CPT, and their roles in quality reporting
• Experience in clinical documentation integrity and quality audits