Baton Rouge General
Responsibilities
The HEDIS Abstractor Specialist will serve to drive Quality performance improvement maximizing member compliance for Verity’s Value-Based Shared Savings Program through medical record abstraction. The position responsibilities include meeting chart abstraction productivity standards, conducting supplemental data collection and abstraction of medical records, and complying with MCO submission guidelines and deadlines.
Responsibilities include but are not limited to:
Performs medical record abstraction in support of the Healthcare Effectiveness Data and Information Set (HEDIS) data collection.
Ability to accurately and efficiently collect data from medical records (electronic and paper) with highest degree of integrity, as evidenced through audits and interrater reliability testing.
Possesses basic clinical and healthcare knowledge; demonstrates the ability to read and interpret medical records; identifies required data within the medical records.
Responsible for leading medical record review project by submitting medical record requests, organization of record retrieval, perform abstraction according to NCQA HEDIS specifications, and accurately documenting chart audit results in appropriate database.
Abstract a chart minimum daily in accordance to policy guidelines while maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, mediation, treatment, health history, interval history, and past history.
Assists the Value-Based Program staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
Provides data collection, presentations and report development support for quality performance improvement projects.
Maintain communication with provider groups by frequent follow-ups with medical record departments to assure accurate member data was provided and retrievable.
Responsible for the coordination and maintenance of the medical record review workflow process for assigned plans and assigned administrative staff.
Assists Director in training and takes the lead role in these activities, utilizing the standardized training materials and job aids.
Responsible for assisting with HEDIS gap in care reporting for provider education and medical record collection.
Provider education sessions as requested by management team.
Always represent the organization well; support its mission, goals and objectives; participate as a “team player”, set an example of high personal and professional conduct for employees and others.
Qualifications
5 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction.
Intermediate knowledge of HEDIS and NCQA.
Strong work management skills - identify a goal and the steps needed to accomplish and proactively manage action steps to reach goals.
Demonstrated understanding and subject matter expertise within any the following areas: managed care regulations, quality reporting, HEDIS measure specifications for contracted measures, and measure abstraction criteria.
Demonstrate excellent organizational skills.
Demonstrate effective verbal and written communication skills.
Demonstrate high attention to detail and a high degree of accuracy.
Ability to develop and maintain deep expertise of Verity HealthNet’s best practices.
Strong interpersonal communication, collaboration, presentation and training skills.
Education Requirements Bachelor's degree or equivalent experience required.
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Responsibilities include but are not limited to:
Performs medical record abstraction in support of the Healthcare Effectiveness Data and Information Set (HEDIS) data collection.
Ability to accurately and efficiently collect data from medical records (electronic and paper) with highest degree of integrity, as evidenced through audits and interrater reliability testing.
Possesses basic clinical and healthcare knowledge; demonstrates the ability to read and interpret medical records; identifies required data within the medical records.
Responsible for leading medical record review project by submitting medical record requests, organization of record retrieval, perform abstraction according to NCQA HEDIS specifications, and accurately documenting chart audit results in appropriate database.
Abstract a chart minimum daily in accordance to policy guidelines while maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, mediation, treatment, health history, interval history, and past history.
Assists the Value-Based Program staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
Provides data collection, presentations and report development support for quality performance improvement projects.
Maintain communication with provider groups by frequent follow-ups with medical record departments to assure accurate member data was provided and retrievable.
Responsible for the coordination and maintenance of the medical record review workflow process for assigned plans and assigned administrative staff.
Assists Director in training and takes the lead role in these activities, utilizing the standardized training materials and job aids.
Responsible for assisting with HEDIS gap in care reporting for provider education and medical record collection.
Provider education sessions as requested by management team.
Always represent the organization well; support its mission, goals and objectives; participate as a “team player”, set an example of high personal and professional conduct for employees and others.
Qualifications
5 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction.
Intermediate knowledge of HEDIS and NCQA.
Strong work management skills - identify a goal and the steps needed to accomplish and proactively manage action steps to reach goals.
Demonstrated understanding and subject matter expertise within any the following areas: managed care regulations, quality reporting, HEDIS measure specifications for contracted measures, and measure abstraction criteria.
Demonstrate excellent organizational skills.
Demonstrate effective verbal and written communication skills.
Demonstrate high attention to detail and a high degree of accuracy.
Ability to develop and maintain deep expertise of Verity HealthNet’s best practices.
Strong interpersonal communication, collaboration, presentation and training skills.
Education Requirements Bachelor's degree or equivalent experience required.
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