DQA Representative

ROLE SUMMARY

The Documentation Quality Assurance Specialist (DQA Specialist) is responsible for reviewing, auditing, reconciling, and validating patient care documentation to ensure accuracy, completeness, regulatory compliance, and billing readiness. This position serves as a quality gate prior to billing submission and supports organizational goals related to documentation quality, revenue cycle integrity, regulatory compliance, and operational excellence.

The DQA Specialist collaborates with field personnel, supervisors, operations leadership, billing teams, clinical leadership, and medical directors to identify documentation deficiencies, provide education and feedback, monitor quality trends, and support continuous improvement initiatives.

This is a Non-exempt/Hourly position.

KEY RESPONSIBILITIES

Documentation Quality Review

• Review patient care reports (PCRs) for completeness, accuracy, consistency, and compliance.
• Audit PCRs to ensure documentation supports medical necessity, reimbursement requirements, and operational standards.
• Verify all required documentation is present prior to billing submission.
• Identify missing, incomplete, or inaccurate documentation and coordinate timely correction with field personnel.
• Reconcile PCRs against CAD records and other operational documentation to ensure all transports are accounted for.
• Monitor documentation compliance with company policies, clinical protocols, and regulatory requirements.
• Review repetitive patient documentation in accordance with company policies and applicable regulations.
• Ensure all documentation meets Priority Ambulance and Confire quality standards.

Compliance and Regulatory Oversight

• Ensure documentation complies with federal, state, and local EMS regulations.
• Ensure compliance with HIPAA, privacy, and confidentiality requirements.
• Support compliance with Medicare, Medicaid, and commercial payer documentation standards.
• Assist with preparation of documentation required for audits, investigations, and regulatory reviews.
• Maintain strict confidentiality of patient, employee, and company information.

Quality Improvement and Education

• Identify documentation trends, deficiencies, and opportunities for improvement.
• Provide documentation feedback and coaching to field personnel.
• Collaborate with Operations, Clinical Services, and Training departments to improve documentation quality.
• Support development and implementation of documentation improvement initiatives.
• Assist with documentation-related training and educational programs.
• Participate in quality improvement projects and performance monitoring activities.

Reporting and Analytics

• Generate and distribute documentation quality reports as assigned.
• Monitor key performance indicators related to documentation quality and compliance.
• Track audit findings, deficiencies, and corrective actions.
• Provide data and trend analysis to management, operations, and clinical leadership.

Billing and Revenue Cycle Support

• Partner with billing personnel to resolve documentation-related issues.
• Assist with retrieval of supporting documentation required for reimbursement.
• Communicate with healthcare facilities, public safety agencies, insurance carriers, and field personnel when additional documentation is required.
• Support efforts to reduce billing delays caused by documentation deficiencies.

Administrative Responsibilities

• Maintain organized and secure documentation systems.
• Ensure all company records are stored and maintained according to company policy and legal requirements.
• Utilize company software systems appropriately and maintain accurate records.
• Protect company technology assets and comply with information security requirements.
• Attend required meetings, training programs, and educational sessions.
• Perform additional duties as assigned.

Performance Expectations

• Maintain established productivity standards for PCR review and reconciliation.
• Meet quality and accuracy standards established by the organization.
• Complete assigned reviews within established turnaround times.
• Demonstrate consistent compliance with company policies and regulatory requirements.
• Contribute to continuous improvement efforts related to documentation quality and billing readiness.
• Support organizational goals related to operational excellence, patient care quality, and revenue cycle performance.

#IND1

QUALIFICATIONS

Education

• High School Diploma or GED required.
• Associate degree in EMS, Nursing, Healthcare Administration, Health Information Management, or related field preferred.

Experience

• Minimum of two (2) years of EMS, healthcare documentation, clinical quality assurance, medical records review, ambulance billing support, or related experience preferred.
• Current or previous EMT, AEMT, Paramedic, RN, or equivalent clinical experience preferred.
• Experience with electronic patient care reporting systems preferred.

Knowledge, Skills, and Abilities

• Knowledge of EMS documentation standards and patient care reporting requirements.
• Knowledge of medical terminology.
• Understanding of Medicare, Medicaid, and commercial insurance documentation requirements.
• Understanding of HIPAA and patient privacy regulations.
• Knowledge of state EMS regulations and applicable healthcare compliance requirements.
• Strong analytical and critical thinking skills.
• Excellent written and verbal communication skills.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency with Microsoft Office Suite.
• Ability to type a minimum of 40 WPM.
• Ability to work independently and collaboratively within a team environment.

PHYSICAL REQUIREMENTS

The employee must be able to perform the essential functions of the position with or without reasonable accommodation.

The employee frequently:

• Ability to sit for extended periods while working at a computer workstation.
• Ability to use computers, keyboards, monitors, and standard office equipment.
• Ability to communicate effectively in person, by telephone, and electronically.
• Ability to occasionally lift and carry up to 25 pounds.

CORE COMPETENCIES

• Attention to Detail
• Accountability
• Integrity and Confidentiality
• Critical Thinking
• Communication
• Customer Service
• Teamwork and Collaboration
• Time Management
• Problem Solving
• Continuous Improvement
• Adaptability
• Professionalism

REPORTING RELATIONSHIP

Reports directly to the Document Quality Assurance Manager.

WORK ENVIRONMENT

• Primarily office-based environment.
• Frequent use of computers and electronic documentation systems.
• Extended periods of sitting and computer work.
• Occasional travel may be required for training, meetings, or operational support.
• May be required to work flexible schedules based on operational needs.

Equal Employment Opportunity / ADA

Priority Ambulance and its affiliated companies are Equal Opportunity Employers. Qualified applicants and employees will receive consideration without regard to any legally protected status. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position, unless doing so would impose an undue hardship or create a direct threat that cannot be reduced or eliminated by reasonable accommodation.

Acknowledgment

This job description is intended to describe the general nature and level of work performed by employees assigned to this position. It is not intended to be an exhaustive list of all duties, responsibilities, or qualifications. Management reserves the right to modify, assign, or remove duties and responsibilities as business needs dictate.