Job Description

Job Description

Job Description

Job Title: Quality Reviewer of Quality Auditors

Location: Remote

Reports to: VP, Coding

ABOUT SHEARWATER HEALTH:

Shearwater Health's global headquarters is located in Nashville, Tennessee. Shearwater provides global healthcare solutions for their partners that improve their service deliveries while lowering costs of operations. The company utilizes their unique Global Healthcare Solutions Model to provide onsite clinical solutions in the U.S., while also delivering remote clinical and administrative services at scale, known as clinical process outsourcing (CPO). With a concentrated focus on the healthcare market, Shearwater combines their clinical expertise and business acumen to assist their clients in delivering better outcomes and care. Shearwater Health works with some of the largest health systems and health plans in the U.S. to expand the size and impact of their nursing teams. In a climate that makes it tough to retain nurses, Shearwater has over 3,500 global clinicians solving medical and administrative problems every hour of every day.

Position Overview: The Quality Reviewer of Quality Auditors is responsible for overseeing and enhancing the effectiveness of our quality assurance (QA) auditing processes. This role involves reviewing the performance of quality auditors, ensuring adherence to organizational and client-specific standards, and providing feedback and support to improve the quality auditing function. As a key quality advocate, the Quality Reviewer identifies and ensures that all quality auditors uphold consistent QA standards.

Key Responsibilities:

• Review Quality Audits: Conduct comprehensive reviews of audits performed by quality assurance specialists to ensure accuracy, completeness, and compliance with Shearwater and client-specific standards.
• Provide Performance Feedback: Deliver constructive feedback and guidance to quality auditors based on audit review results to enhance consistency and adherence to best practices.
• Analyze and Report Trends: Prepare and present data-driven reports, including trend analysis, to inform process improvements and maintain quality standards.
• Support Quality Initiatives: Work closely with QA teams to improve quality metrics and assist in the development of standards.
• Monitor Client Feedback: Review client grievances, commendations, and customer feedback, ensuring it is accurately incorporated into the quality review process and addressing client needs and expectations.
• Facilitate Calibration Sessions: Coordinate regular calibration sessions to align quality auditors on quality standards and ensure a unified approach to quality assessments.
• Promote QA Best Practices: Act as a subject matter expert in quality assurance, continually disseminating knowledge of QA best practices and supporting quality auditors in their professional development.
• Enhance QA Standards: Collaborate with Supervisors and the Continuous Improvement Manager to refine and update QA standards, ensuring alignment with organizational goals and industry best practices.

Qualification Requirements:

• Bachelor’s degree in Business Administration, Healthcare Administration, Quality Assurance, or related field.
• 10+ years of experience in both Inpatient and Outpatient medical coding auditing
• AHIMA or AAPC credential required
• Experience in working with colleagues in offshore locations is required

• Strong understanding of healthcare BPO standards, regulations (e.g., HIPAA), and QA best practices.
• Detail-oriented with expertise in reviewing audits and identifying improvement areas.
• Proficient in quality management software and data analysis tools.

• Excellent verbal and written communication skills.
• Ability to provide clear feedback and collaborate effectively across teams.

• Strong analytical skills with a focus on process improvement.
• Ability to handle multiple priorities and meet deadlines.

Job Tags

Similar Jobs