Quality Compliance Professional

The Quality Compliance Professional will conduct audits and assessments to ensure adherence to organizational policies, regulatory requirements, and quality standards, supporting continuous improvement by identifying risks and recommending corrective actions. Responsibilities include conducting medical record reviews for proper documentation, coding, care coordination, and accurate outcome reporting. The role involves planning and performing quality compliance audits across external provider types, reviewing medical records for supplemental data, and evaluating compliance with NCQA, CMS, and DMAS standards. Analyzing audit findings, preparing detailed reports, providing guidance and training on best practices, monitoring remediation plans, and preparing reports for senior management are also key duties. The professional will collaborate with staff to promote best practices and ensure alignment with compliance goals, while maintaining current knowledge of laws, regulations, and industry standards.