Job Description

Job Description

Job Description

THIS IS NOT A REMOTE POSITION

Under the direct supervision of the Supervisor, Nurse Analyst, the Quality Medical Record Abstractor will be responsible for conducting data collection and abstraction of medical records for HEDIS projects, HEDIS like projects, supplemental data collection, and other quality key performance indicators, as well as supporting quality improvement initiatives and auditing projects.

Required:

1. Certified Medical Coder with a minimum of three years’ experience in a healthcare setting.
2. Proficient in Microsoft products.
3. Experience in the use of a variety of Electronic Medical Records including EPIC systems .
4. Demonstrated experience in data collection, medical record review and data abstraction.
5. Able to complete tasks in a timely manner.
6. Detail oriented with problem solving abilities.
7. Strong critical thinking, analytical skills, and the ability to work in a fast paced environment.
8. Strong written and verbal communication skills.

Desired:

1. Managed care experience.
2. Primary Care or outpatient medical coding experience.
3. HEDIS/NCQA experience or understanding.
4. Relevant work experience in quality improvement or process improvement.

Responsibilities:

1. Coordinates outreach efforts to request, collect, and secure clinical documentation from network providers and facilities in a timely manner.
2. Performs medical record abstraction to support specified and required clinical data elements for HEDIS measures, quality improvement initiatives, and auditing projects.
3. Documents chart audit findings in applicable chart audit tools.
4. Assures medical record chart abstractions are completed timely and in accordance with HEDIS technical specifications and guidelines.
5. Makes recommendations for process improvements and provider education related to chart audit findings and HEDIS specifications and medical record coding.
6. Assists in the development of provider training to accomplish established corporate quality goals related to improved coding.
7. Collaborates with Clinical Services, Quality Improvement, Medical Economics and the Provider Delivery Services departments to develop data driven provider and member initiatives.
8. Maintains accuracy ratings and performance goals as defined by the Quality Improvement Department.

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