Healthcare Quality Process Specialist

SUMMARY OF PRIMARY RESPONSIBILITIES

The Healthcare Quality Process Specialist is responsible for providing quality control and auditing oversight related to RMS’ CAHPS® survey administration within the Healthcare Division. The individual in this position will be fully competent with the CAHPS survey techniques and protocol, remaining compliant with government protocols. The individual is responsible for ensuring the quality, accuracy, integrity, and compliance of RMS’ healthcare survey processes, documentation, data collection activities, and reporting outcomes ensuring compliance with oversight guidelines from each RMS assigned CMS CAHPS Coordination Team. This individual will be responsible for documenting and maintaining training documents detailing the specific steps of RMS’ survey administration processes. The position will serve as a key liaison with the CMS Coordination Teams for each line of RMS CAHPS business. The specific work will involve conducting audits, analyzing and monitoring quality metrics, identifying improvement opportunities, and collaborating with operational teams to support regulatory compliance and continuous quality improvement initiatives while regularly engaging with various CAHPS Coordination Teams. Proficiency with use of the Microsoft® Excel, Word, and Voxco survey software, telephone follow-up with Coordination Teams as needed, and utilizing various pieces of office equipment. The individual will provide and assist with training, operational decision-making and general management guidance to healthcare analytic team members.

ESSENTIAL RESPONSIBILITIES

• Responsible for ensuring compliance with CMS CAHPS protocols and Quality Assurance Guideline (QAG) requirements for all lines of business.

• Conduct internal audits of healthcare survey processes, review procedure documentation, and establish quality measures, documenting

• key process milestones.

• Responsible for reviewing CMS developed Quality Assurance Guidelines and Protocols and Guidelines for each RMS approved lines of business, comparing them to internal RMS Quality Assurance Plans to ensure alignment with requirements.

• Responsible to work with the Director, Survey Operations and Chief Operating Officer to ensure successful development, management and evaluation of annual Quality Assurance Plans (QAPs) for all RMS CAHPS lines of business and facilitating quality improvement (QI) projects throughout the organization. Oversees regularly scheduled internal quality audits, working with the Director, Survey Operations and Chief Operating Officer.

• Works to identify streamlined processes and administrative functions to maximize efficiencies while ensuring quality deliverables.

• Develops (and/or reviews) documentation and maintains survey administration policies and procedures, with specific attention to documenting workflow processes to ensure full compliance with all internal QAPs. Tests procedures to ensure that all steps detailed yield a consistent, desired result.

• Creates and maintains a master calendar by RMS CAHPS product line documenting audit record deadlines, quality report production, and necessary compliance documentation.

• Maintains communication with key stakeholders (especially the CAHPS Operations teams) to ensure all deliverables are scheduled, managed and executed timely and in accordance with CMS timelines.

• Establishes and maintains collaborative partnerships with all pertinent RMS departments to achieve organizational and administrative matters.

• Responsible to develop and maintain reports and compliance documentation to demonstrate compliance with annual Quality Assurance Guidelines.

• Regularly meets with designated staff to conduct trainings and address operational issues.

• Participates weekly in the CAHPS Operations meeting sessions.

• Maintains strict adherence to Corporate Code of Conduct and compliance policies and supports the mission and values of Research & Marketing Strategies, Inc. (RMS)

• Performs other related duties as assigned to meet overall departmental and divisional goals.

PREFERRED POSITION REQUIREMETS

• A minimum of a bachelor’s degree is required, preferably in Healthcare Administration, Public Health, Health Information Management, Quality Management, Business Administration, or related field.

• Five (5) or more years of healthcare quality, compliance, auditing, or process improvement experience.

• Experience supporting regulatory reviews, accreditation surveys, or quality assurance programs.

KNOWLEDGE, SKILLS & ABILITIES

• Quality assurance and quality improvement principles

• Healthcare regulator and compliance knowledge

• Analytical and critical thinking skills

• Data analysis and reporting capabilities

• Project management and organizational skills

• Strong written and verbal communication

• Attention to detail and accuracy

• Ability to work independently and collaboratively

• Willing to uphold a commitment to excellence

• This position is eligible for a hybrid work model. Staff will be required to be in the office three days a week.

PHYSICAL REQUIREMENTS

Ambulatory 15% Sedentary 85% Computer Work 85% Travel None required at this time

This position requires access to patient Protected Health Information (PHI) and will also involve access to electronic Protected Health Information (ePHI). Those in this position are required to comply with all final regulations including the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Intentional or inadvertent disclosure of PHI or ePHI violates federal law and can result in termination and/or fines. Additionally, employees in this position are required to notify the Privacy and/or Security Officer of any suspected incidents whereby RMS is not in full compliance with HIPAA. RMS will provide HIPAA training opportunities and venues for the employee to remain abreast of HIPAA requirements.