LPN Quality Specialist

Quality Specialist
Saltville, VA | Integrated Care | Mission-Driven Work
The Quality Specialist serves as a subject matter expert in value-based payment programs, quality reporting, and population health initiatives. This role is responsible for leveraging payer data, analytics platforms, and clinical collaboration to drive quality performance, close care gaps, and support risk-based reimbursement strategies.

This position plays a critical role in optimizing performance in programs such as MSSP, ACO initiatives, and other value-based arrangements by aligning clinical documentation, coding accuracy, and payer reporting. Key Responsibilities
Value-Based Care & Population Health

• Analyze and utilize payer quality reports to drive population health strategies and improve clinical outcomes
• Identify high-risk, high-utilization patients and support development of team-based care plans
• Track organizational performance on quality metrics and identify cost-sharing or incentive opportunities
• Partner with care teams to close care gaps and improve HEDIS, UDS, and other quality benchmarks

Data Analytics & Reporting

• Serve as a super-user for Azara DRVS and Aledade platforms, including report generation, validation, and issue resolution
• Run and interpret monthly and quarterly quality and performance reports
• Maintain data integrity and ensure accurate submission to payer portals

Coding & Documentation Integrity

• Review ICD-10, CPT, and HCPCS coding for accuracy, completeness, and compliance
• Validate provider documentation to ensure alignment with diagnoses and services rendered
• Provide education and feedback to providers on coding best practices and documentation improvement

Quality Assurance & Compliance

• Participate in internal audits and quality assurance activities
• Ensure timely and accurate completion of medical reports and documentation workflows
• Maintain compliance with federal, state, HRSA, and organizational standards

Stakeholder Collaboration

• Act as liaison between providers, billing, and payer organizations
• Build and maintain relationships with payer representatives to optimize performance and resolve issues
• Provide case-specific feedback and education to clinicians and care teams

Professional Development

• Stay current on value-based care, healthcare quality, and coding regulations through ongoing education

Qualifications

• Active LPN/RN License in the Commonwealth of Virginia required.
• 3+ years of experience in healthcare quality, population health, medical coding, or value-based care programs preferred
• Experience in FQHC, ACO, or risk-based reimbursement models strongly preferred

Equal Employment Opportunity & E-Verify Statement

Southwest Virginia Community Health Systems, Inc. is an Equal Opportunity Employer and is committed to fostering a diverse and inclusive workplace. We do not discriminate in employment opportunities or practices on the basis of race, color, religion, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), sexual orientation, gender identity or expression, national origin, ancestry, age, physical or mental disability, genetic information, marital status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

We are committed to providing reasonable accommodations to qualified individuals with disabilities and to applicants and employees with sincerely held religious beliefs, in accordance with applicable law.

Southwest Virginia Community Health Systems participates in the E-Verify program. All newly hired employees are required to complete Form I-9 and will have their employment eligibility verified through E-Verify in accordance with federal law.

In compliance with the Immigration Reform and Control Act of 1986, all individuals hired must provide documentation establishing identity and authorization to work in the United States. SVCHS does not use E-Verify to pre-screen applicants and will not take adverse action against an individual based solely on tentative non-confirmation results.

Applicants requiring assistance with the application process due to a disability may contact Human Resources for support.