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.
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
Proficiency in EMR systems (Altera preferred)
Intermediate Microsoft Word, Outlook, and Excell skills required
Experience using databases or electronic record-keeping systems to enter, manage, extract, and validate data for reporting, tracking, and quality monitoring
Strong attention to detail and accuracy with sensitive information
Ability to prioritize tasks and manage multiple responsibilities
Strong verbal and written communication skills
Ability to maintain effective working relationships with providers, staff, leadership, and external contacts
