OVERVIEW
The Data Quality Specialist is responsible for leading initiatives that enhance coding quality, clinical documentation integrity, and performance under QBP–HBAM–HIG methodologies. This role ensures the accuracy, completeness, and compliance of health data abstracted and submitted to the Canadian Institute for Health Information (CIHI) and the Ministry of Health (MOH).
This position plays a key role in safeguarding hospital funding under HBAM, HIG, and QBP methodologies by ensuring the accurate assignment of ICD-10-CA/CCI codes, Case Mix Groups (CMG), Case Mix Index (CMI), Comprehensive Ambulatory Classification System (CACS), Resource Intensity Weights (RIW), and Expected Length of Stay (ELOS).
The Specialist leads and executes data quality audits, including collaboration with third-party consultants, and develops advanced quality reporting and audit tools using Crystal Reports, MS SQL Server, Power BI, and other enterprise reporting systems. The position works closely with Health Information Management (HIM), Clinical Programs, Decision Support, and Data Analytics teams to promote data integrity at the source and ensure reliability across enterprise reporting and hospital performance monitoring.
Education
- Undergraduate Degree (minimum 3-year) in Health Information Management or related discipline.
- Active CHIMA certification in Health Information Management.
Experience
- Minimum 3-5 years of progressive experience in hospital coding and abstracting.
- Demonstrated ability to code in ICD-10-CA/CCI and abstract in the CIHI Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS).
- Demonstrated knowledge of CMG, CMI, CACS, RIW, and ELOS methodologies.
- Demonstrated experience with HBAM, HIG, and QBP funding methodologies.
- Experience developing and executing coding audits and documentation reviews.
- Experience working with third-party consultants on quality improvement initiatives.
Technical Competencies
- Demonstrated knowledge and ability to design reports using Crystal Reports.
- Demonstrated proficiency in MS SQL Server and SQL query development.
- Experience utilizing Python for data analysis and quality monitoring.
- Working knowledge of Cerner clinical systems and related reporting environments.
- Advanced knowledge of ICD-10-CA/CCI coding methodology.
- Strong working knowledge of HBAM, QBP, and hospital funding methodologies.
- Proficient in Microsoft Office applications including Word, Excel, and PowerPoint.
- Strong analytical, problem-solving, and data interpretation skills.
- All employees of Michael Garron Hospital (MGH), a division of Toronto East Health Network (TEHN) [formerly Toronto East General Hospital (TEGH)] agree to work within the legislated practices of the Occupational Healthand Safety Act of Ontario.
- All employees of MGH are responsible to contribute to a transparentculture of patient and staff
safety by adhering to and abiding by patient and staff safety policies and procedures set by MGH.
- All employees are accountable for protecting the psychological health and safety of themselves and their co-workers through adherence to MGH's policies and practices.
