Clinical Quality Specialist

Summary

Join SmarterDx as a Quality Measurement Coding Specialist and play a key role in the launch of our new Quality Measurement and Reporting product. Collaborate with Product and Data Science teams to refine strategies that help customers improve clinical quality scores. Apply your clinical expertise to quality reporting, defining models, rules, and workflows for various quality programs. This fully remote US-based role requires evaluating technology-generated recommendations, ensuring alignment with quality measure specifications and regulatory requirements, and translating quality measures into actionable rules. You will identify documentation gaps, collaborate on quality measure support, and serve as a subject matter expert, advising on clinical logic. Contribute to product strategy by validating model outputs and enhancing AI workflows impacting quality scoring and reporting.

Requirements

• Deep knowledge of clinical quality programs including MIPS, HEDIS®, Star Ratings, APMs, or IQR
• Experience interpreting and applying quality measure specifications to clinical workflows or coding practices
• Experience in clinical documentation integrity (CDI) and quality audits
• Strong understanding of ICD-10-CM, CPT, Z-codes, and their roles in quality reporting
• Familiarity with electronic medical records, abstraction workflows, or payer quality reporting mechanisms
• Previous experience, or strong interest, in advising or consulting for healthcare technology companies, with a passion for leveraging AI to support clinical and quality performance
• Medical degree (RN, or similar clinical background)
• Clinical background with experience in Inpatient Quality Reporting or Coding for Value-Based Care
• Ability to grow and contribute across multiple functions as the role evolves

Responsibilities

• Evaluate whether technology-generated recommendations are clinically supported by documentation in the chart
• Ensure technology-generated quality coding suggestions align with national quality measure specifications and regulatory requirements
• Translate CMS, NCQA, and payer quality measures into actionable documentation and coding rules
• Identify gaps in clinical documentation that prevent accurate reporting of quality measures such as those in HCC, Elixhauser, HAC, PSI, 3rd Party, and other regulatory quality programs
• Collaborate with cross-functional teams to develop and optimize quality measure support, including ICD-10, CPT, and SNOMED mapping
• Serve as the subject matter expert on documentation and coding requirements for quality programs, advising product development on clinical logic and edge cases
• Contribute to product strategy by validating model outputs and enhancing AI workflows that impact quality scoring and reporting

Preferred Qualifications

• Clinical background with experience in Outpatient Quality Reporting or Coding for Value-Based Care
• Experience with quality audits, submissions, or abstraction
• Prior advising or consulting experience with healthcare technology companies
• Familiarity with CMS quality measure updates and regulatory guidance
• Strong leadership abilities, particularly in managing RN/MD teams reviewing documentation for quality measure compliance

Benefits

• $115k - $140k base + equity
• Medical, Dental & Vision – Comprehensive plans with leading insurance providers, covering 90-100% of your premiums and 70-90% for dependents, depending on the plan
• One Medical Membership – Free membership included if you enroll in a SmarterDx medical plan
• Paid Parental Leave – Up to 12 weeks of paid leave for birth or adoption
• Remote-First Team – Work from anywhere in the U.S. with a $400 home office reimbursement stipend
• Unlimited PTO & 10 Holidays – 4 of which include floating holidays so you can recognize the days that matter most to you
• Learning & Development Budget – $500 per year (prorated) for courses, books, and resources to expand your skills
• 401(k) with Traditional & Roth Options – Tax-advantaged retirement savings through Empower