AtlantiCare · 4 days ago
PACE Quality Analyst
Atlantic City, NJ
Full-time
Onsite
Senior Level
5+ years expAtlantiCare is a health system dedicated to enhancing the quality of care for its participants. The Quality Analyst role focuses on ensuring regulatory compliance, quality performance, and data integrity within the PACE program, serving as a liaison between interdisciplinary teams and regulatory bodies.
CRMFitnessHealth CareInformation Technology
Responsibilities
Interpret and apply CMS, HIPAA, and NJ DOH regulations to participant record management, retention, and access
Develop, maintain, and implement policies and procedures for medical record documentation and compliance activities
Perform internal audits of participant medical records, tracking timeliness, completeness, accuracy, and regulatory compliance
Conduct comprehensive chart reviews to identify all clinically relevant, CMS –acceptable diagnosis for HCC capture
Collaborate with finance, quality and clinical departments to ensure HCC coding accuracy based upon CMS Risk Adjustment Guidelines
Stay current with annual HCC model changes, ICD-10 updates, CMS Memos, NPA Guidance and Audit trends
Serve as the primary compliance liaison for all HIM-related activities, supporting audits, process improvements and surveys
Coordinate secure data exchange with hospitals and contracted facilities through HIE or direct methods to ensure record exchange compliance and interdisciplinary documentation consistency
Ensure consistency between care plans, MARs, and progress notes through regular reconciliation
Develop compliance and HIPAA training materials for staff; lead education sessions on documentation best practices
Educate providers on risk-adjusted documentation standards, specificity requirements, and annual condition re-assessment rules
Assist with investigation and reporting of privacy breaches, documenting corrective actions per CMS and HIPAA standards
Support implementation and optimization of EHR systems (Cerner, PACE Logic) to enhance data accuracy, efficiency and compliance tracking
Generate data dashboards and reports on audit trends, compliance metrics, and corrective action outcomes for QA Committee review
Provide data abstraction for QAPI indicators and trend analysis for quality performance improvement and reporting
Assist with the creation & monitoring of PDCAs in place for quality & process improvement
Monitor & mediate corrective action plans & immediate corrective action plans that were developed from regulatory deficiencies & CMS Audits
Qualification
Required
Bachelor's degree required with 5 years job related field experience
Proficiency in Microsoft Suite with strong focus on Microsoft Excel
EMR proficiency (Cerner, PACE Logic, or equivalent)
5 years' experience in medical records coordination, compliance, or quality oversight (PACE/LTC/Home Care Preferred)
Must possess a comprehensive understanding of CMS regulations, HIPAA Privacy & Security Rules, and documentation standards
Must possess strong analytical & organizational skills, with attention to regulatory detail
Benefits
Generous Paid Time Off (PTO)
Medical, Prescription Drug, Dental & Vision Insurance
Retirement Plans with employer contributions
Short-Term & Long-Term Disability Coverage
Life & Accidental Death & Dismemberment Insurance
Tuition Reimbursement to support your educational goals
Flexible Spending Accounts (FSAs) for healthcare and dependent care
Wellness Programs to help you thrive
Voluntary Benefits , including Pet Insurance and more
Company
AtlantiCare
AtlantiCare is a provider of health information and health engagement with emphasis on healthy, at-risk, acute or chronic illnesses.
5001-10000 employees
H1B Sponsorship
AtlantiCare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (6)
2024 (5)
2023 (11)
2022 (9)
2021 (3)
2020 (8)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Exact Sciences
2022-09-22Grant
Leadership Team
Michael Charlton
President and CEO
Jordan Ruch
Chief Information Officer
Recent News
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