Quality improvement specialist vs compliance specialist

Differences between quality improvement specialist and compliance specialist duties and responsibilities

Quality improvement specialist example responsibilities.

• Manage action planning as it relates to the RCA process.
• Design, run, and manage the HEDIS data review process/claim encounters to ensure accuracy and integrity of data.
• Lead company-wide preparation for NCQA accreditation.
• Assist organization in achieving strategic quality/resource consumption goals and JCAHO accreditation.
• Design and manage an internal SharePoint site utilize compliance with RESPA guidelines
• Manage investigations using applicable methodology focuse on root cause analysis and CAPA identification / implementation.
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Compliance specialist example responsibilities.

• Lead bi-weekly Medicaid meetings to maintain effective communication with all staff regarding AHCA updates and notifications.
• Manage and submit regulatory permit and notification applications to USDA to import, move and release regulate plant materials.
• Participate in OCC exam preparation and review including research and presentation of documentation to achieve compliance with federal examiner requests.
• Access the IDX system to obtain patient billing information in order to review Medicare and Medicaid payments.
• Develop training materials to be used company-wide for regulatory mandate continuing education; create written policy manual for ethics and compliance.
• Perform SOX control testing and validation.
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