Inovalon

Quality Assurance Team Lead

US-MD-Bowie
Requisition ID
2017-7765
Category (Portal Searching)
Operations

Overview

Inovalon is a leading technology company that combines advanced cloud-based data analytics and data-driven intervention platforms to achieve meaningful insight and impact in clinical and quality outcomes, utilization, and financial performance across the healthcare landscape. Inovalon's unique achievement of value is delivered through the effective progression of Turning Data into Insight, and Insight into Action.

 

The Quality Assurance Team (QAT) Lead, will report directly to the QAT Quality Manager.  In this role the incumbent will be responsible for overseeing a group of QAT members. The QAT Lead will assist and oversee Quality improvement initiatives performed by the Quality Assurance Team to ensure that high quality medical record reviews are completed by the over-reader staff and Lead staff.

Responsibilities

  • Perform quality re-overreads of the Over-reader and Lead staff;
  • Compile, document, track and report the Quality staff accuracy rates;
  • Supervise the delivery of feedback to the staff member reviewed, regarding accuracy scores and assist in identifying opportunities for improvement;
  • Provide helpful hints for training, manual updates and knowledge base submissions based on identified trends;
  • Gather and track data to identify opportunities for process improvement within the company;
  • Assist with the training and in-service presentation of processes;
  • Monitor daily attendance including, but not limited to tardiness and absence;
  • Develop and submit improvement plans for team members as needed;
  • Prepare weekly team activity reports, such as escalation reports, and analytics activities;
  • Recommend management actions that might improve standards and departmental operating procedures;
  • Complete all annual evaluations and submit to QM for approval;
  • Hold responsibility for the quality and efficiency of the clinical quality review process and the assigned quality analytics review team;
  • Assist with the design, execution, and management of ongoing quality assessment procedures for all review personnel;
  • Ensure quality analytics team is maintaining high standards of quality and reliability;
  • Enforce quality requirements and standards;
  • Assist with the development, organization and implementation of company-wide quality improvement efforts;
  • Maintain the control and ongoing monitoring of quality and reliability as well as quality reporting mechanisms and management tools;
  • Ensure compliance with contractual, local, state and national quality standards;
  • Maintain ongoing proficiency across all product lines; and
  • Make recommendations for process and technical changes, and document applicable changes as needed.

Qualifications

  • Licensed nurse with at least 5 years of coding experience and at least 2 years of clinical experience or a certified coder with at least 5 years of coding experience;
  • Strong knowledge of Risk Adjustment;
  • Strong working knowledge of medical terminology, coding guidelines and regulations as they relate to Risk Adjustment;
  • Computer literate including proficiency in Microsoft Office applications;
  • Ability to manage and meet deadlines, with strong attention to detail;
  • Professionally skilled in written and verbal communication;
  • Strong presentation and interpersonal skills;
  • Previous management experience preferred; and
  • Previous analytics/auditing experience preferred.

 

Inovalon provides equal employment opportunities (EEO) to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or protected veteran status and will not be discriminated against on the basis of disability. 

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