Clinical Quality Specialist

Job Summary :

The Clinical Quality Analyst is responsible for monitoring and improving patient care standards across clinical operations. This role supports quality improvement initiatives by analyzing clinical and administrative data and implementing performance improvement projects to enhance patient outcomes and ensure compliance with regulatory and payer requirements. This position plays a key role in supporting value-based care, pay-for-performance programs, and Accountable Care Organization (ACO) initiatives.

Essential Functions and Responsibilities:

• Support payer-driven quality programs across Medicare, Medicare Advantage, Medicaid, and commercial plans
• Collect, analyze, and interpret clinical, administrative, and payer data to identify trends, care gaps, and performance improvement opportunities
• Collaborate with providers, clinical staff, and leadership to improve documentation, workflows, and patient outcomes
• Assist in the development, implementation, and monitoring of quality improvement (QI) initiatives
• Develop and support education initiatives, including onboarding, staff training, newsletters, and presentations
• Track provider performance and cost-related quality measures to support value-based care initiatives
• Manage quality databases and reporting tools used to track performance metrics and compliance outcomes
• Support quality reporting activities, including ASC Quality Reporting, CMS, HEDIS, NCQA, and payer-specific requirements
• Conduct chart audits and clinical documentation reviews to ensure accuracy, compliance, and adherence to regulatory and payer standards
• Submit supplemental data to payers and manage payer portal submissions and communications
• Support audit, survey, and compliance readiness through accurate documentation and reporting materials