Description:

HEDIS and Chart chase experience required

Mon-Fri- 8-5 CST, fully in office, after hours and Weekend work may be required

This is for the Quality SDS/PSV Operations Department.

1-2 week training, limited time off, will be discussed during interview.

Please send candidates with HEDIS®, DSNP, and Quality experience

HEDIS Operations combines talented individuals from many areas of quality, including HEDIS, CAHPS and Accreditation. Our goal is extraordinary performance that exceeds the expectations of stakeholders, customers and members we serve.

In this position, you will work with the Quality SDS/PSV Operations staff to assist with data collection of DSNP data.

The purposes of this role include, but are not limited to:
1\. Market specific data mining, data entry and collection
2\. Medical record review and abstraction for HEDIS and HEDIS-like measures
3\. Other duties as assigned

The candidate must be technically savvy and must be able to work without distraction. This is a high production environment, and candidates must adhere to measured productivity and quality requirements.

Responsibilities:
• Reviews assigned medical records in order to verify clinical data elements for HEDIS reporting,
• Identifies findings supported by documentation guidelines with high level of accuracy
• Maintains HIPAA standards and confidentiality of protected health information; reports critical incidents immediately.
Prioritize and organize own work to meet agreed upon deadlines.
• Communicates identification of pursuit leads for additional medical records, if needed, to other members of the team
• Attends conference calls as necessary to provide information relating to clinical reviews and compliance
• Successfully completes HEDIS technical specification training and testing
• Successfully completes HEDIS software training and uses software correctly
• Performs other duties as assigned

Essential Job Functions
1\. Assisting in the review of medical records to highlight Star/HEDIS opportunities for the medical staff.
2\. Review medical records for data collection, data entry, and quality monitoring that close gaps in care.
3\. Partner with the leadership team, the practice administrative or clinical staff to identify trends observed and potential strategies to support the practice.
4\. Communicate challenges or trends that may negatively impact quality outcomes.
5\. Track and trend barriers/challenges that exist at their assigned groups so that better outcomes can be achieved including access to appointments lack of follow up on referrals, or inconsistent coding practices.
6.Navigate multiple documentation systems and obtain medical record sections supportive of HEDIS/Star measures.
7\. Support quality initiatives by requesting medical records from provider’s offices as needed.
8\. Receives and responds to incoming Clinical Quality inquiries from all communication venues: e.g. phone and fax queue, TruCare, or department e-mail box.
9\. Conducts in-bound and out-bound calls for quality requirements including, but not limited to: medical records requests, contact verification.
10\. Provides clerical and/or administrative support to quality staff and managers for special projects and reporting needs.
11\. Provides excellent customer service by serving as a resource to all internal and external customers.
12\. Maintains education/knowledge base of HEDIS/STARs.
13\. Datamining


Minimum Required Education, Experience & Skills
• High School Diploma or GED required.
• Two years of administrative support experience.
• Experienced using Microsoft Office applications, including Excel, Word, and Outlook.
• Must be able to work independently, with some supervision and direction from manager.
• Possesses medical terminology knowledge base.
• Must possess and demonstrate excellent organizational skills, customer service skills, to include verbal and written communication. Must maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times.
• Must maintain strict confidentiality at all times.
• Must adhere to all department/ organizational policies and procedures.

Preferred Education, Experience & Skills
• Certified Medical Assistant training or certification preferred.
• Two or more years of experience in a physician’s clinic or hospital preferred.
• Additional years of experience working in a medical care setting as a receptionist or medical assistant.
• Bilingual language proficiency (English/Spanish).
• Three or more years of experience with data analysis/quality chart reviews
• One or more years of HEDIS/STAR experience or participation with similar quality regulatory reporting.
• EMR and HEDIS knowledge and experience