Clinical Quality Specialist

Role

The Clinical Quality Specialist will play an important role in SmarterDx’s next product launch in the Quality Measurement and Reporting space. This role will work closely with Product and Data Science teams to refine and collaborate on strategies that enable our customers to improve clinical quality scores and accurately reflect care delivered through compliant coding. This specialist will bring a creative and clinical view to quality reporting and assist in defining models, rules, and workflows that drive performance on HCC, Elixhauser, HAC, PSI, 3rd Party, and other regulatory quality programs.

SmarterDx builds clinical AI that empowers hospitals to achieve 100% chart accuracy for revenue integrity. Our solution helps hospitals tell the most accurate and complete story of the patient and the care that was delivered, which helps them recover millions in earned revenue and improve quality of care scores. Become a Smartian and help optimize the way the healthcare system works for everyone. Learn more at smarterdx.com/careers. 

**This role is fully remote within the US**

What You’ll Do

• 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.

What You Bring

• 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.

Must Haves

• 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

Nice To Haves

• 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

Compensation

• $115k - $140k base + equity

#LI-Remote