Quality Specialist

• Lead and organize training for all Quality Specialists on audit processes, procedures, and tools.
• Conduct complex audits and verifying quality standards for selected inquiries and make decisions whether discrepant information meets BCBSA and FEP audit requirements, state, and federal mandates.
• Provide second-level support on escalated issues and audit findings.
• Collaborate with team members, OCLD, and management to identify training gaps and business needs and implement actions while partnering to address these issues.
• Review, evaluate, and provide feedback on trainees’ audits and learning processes.
• Act as a consultant with external departments to help resolve high-impact business issues by recommending action plans related to quality assurance.
• Assist the Data Reporting Analyst in collecting data and providing analyses for various issues across the department and other functional areas.
• Foster a training and auditing culture that values diversity of thought, leveraging team member strengths to achieve team goals.
• Assist with external audits and lead special projects.
• Perform other duties as assigned.

Quality Specialist III ensuring compliance and conducting complex audits at Premera.

Quality Specialist III

Quality Specialist III role at Premera focusing on compliance, quality assurance, and auditing within healthcare services.

• Perform clinical validation to ensure measure accuracy and compliance with CMS requirements
• Conduct medical record abstraction for assigned measures
• Identify and resolve data and logic discrepancies in collaboration with internal teams and external vendors
• Support timely and accurate regulatory submissions
• Ideally, team members will be assigned to either Validation or Abstraction
• Cross-training will be provided to support workload balancing and team flexibility.

RN Quality Measure Specialist focused on clinical quality measures at Banner Health

RN Quality Measure Specialist

RN Quality Measure Specialist at Banner Health validating and abstracting clinical quality measures. Collaborating with teams to support regulatory and quality reporting initiatives in a remote work setting.

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Quality Specialist III

RN Quality Measure Specialist