Clinical Documentation & Quality Improvement Specialist

Career at Callmax Solutions - Philippines

Imus

On-site

PHP 300,000 - 540,000

Full time

2 days ago

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Job summary

Career at Callmax Solutions - Philippines is seeking a detail-oriented Medical Documentation Reviewer to support accuracy and compliance of clinical records. You will interpret progress notes, identify discrepancies, and ensure documentation aligns with billing, coding, and quality measures.

The ideal candidate has advanced English, strong medical terminology, and experience with EMR/EHR systems (eCW preferred).

Qualifications

Strong medical terminology and clinical documentation knowledge.
Experience reviewing and interpreting progress notes and patient charts.
Understanding continuity of care measures, preventive care workflows, and quality metrics.
Knowledge of insurance audit prevention and documentation compliance standards.
Familiarity with HEDIS, quality measures, risk adjustment, or value-based care preferred.
Experience within the U.S. healthcare system strongly preferred.
Experience with EMR/EHR systems (preferably eClinicalWorks/eCW) preferred.
Advanced English level required (written and verbal communication).
Strong analytical skills and attention to detail.
Ability to work independently and manage sensitive/confidential information appropriately.
Excellent written and verbal communication skills.

Responsibilities

Review and interpret clinical progress notes for accuracy, completeness, and consistency.
Identify discrepancies, missing documentation, or potential compliance concerns.
Ensure documentation supports continuity of care measures and quality initiatives.
Review encounters to confirm alignment between diagnosis, treatment plans, referrals, orders, and follow-up care.
Support prevention of insurance audits by identifying risk areas proactively.
Verify that documentation supports billing, coding, medical necessity, and payer requirements.
Monitor quality measures (HEDIS/QCM/Preventive Care metrics) and ensure proper clinical documentation.
Communicate documentation concerns and recommendations to providers and operational leadership.
Assist in workflow optimization related to patient care documentation and compliance.
Maintain knowledge of HIPAA regulations and documentation standards.
Participate in internal quality improvement initiatives and chart audits.