Presbyterian Healthcare Services
Senior Quality Improvement Abstract
Presbyterian Healthcare Services, Albuquerque, New Mexico, United States, 87101
Overview
Senior Quality Improvement Abstract position at Presbyterian Health Services. Oversees and performs the Medical Record Retrieval, Review and Reporting process to support HEDIS, STARs, HEDIS Like, supplemental, and other required regulatory reporting as well as PHP Board approved health management initiatives across the enterprise. The role assists with ensuring clinical and fiscal improvements and documents service delivery in accordance with Presbyterian Health Plan policies. The Senior Abstractor will perform duties where clinical decision-making may be necessary, including training and over-read responsibilities.
Base pay range $24.62/hr - $37.58/hr
Why Join Us Presbyterian is dedicated to improving people’s lives — the lives of our patients and coworkers. We are locally owned and operated, with supportive leadership that empowers employees and opportunities to grow from entry-level to senior positions.
Responsibilities
Uses Performance Improvement tools to develop work plans, tasks, timelines, and measurements for health management projects; plan milestones and monitor progress.
Identify needs, design data collection tools, analyze data and claims, provide feedback, and monitor outcomes and quality of services.
Perform Medical Record Reviews to support quality initiatives and regulatory reporting (HEDIS, CMS Star measures, FEHB, Medicaid, supplemental data); manage productivity and over-read standards as applicable.
Manage an assigned caseload of provider locations; provide verbal and written progress on provider submissions for requested medical records; communicate effectively with providers.
Identify, analyze, and collect clinical information for HEDIS/NCQA requirements; document findings in HEDIS database tools; track issues and outcomes related to abstractions and over-reads.
Integrate data from electronic and paper sources; communicate significant findings to management in a timely manner.
Auditing to ensure data abstraction accuracy; mentor abstractors to improve skills; assist in site visits and on-site medical record abstraction as needed.
Handle record requests via appropriate methods (fax, email, mail, site visits) and convert files to usable formats; ensure proper file naming and storage on shared drives.
Follow HEDIS Technical Specifications to obtain and evaluate medical record documentation for HEDIS measures.
Assist in developing criteria for medical record and site reviews; contribute to educational and training materials.
Identify barriers and plan interventions to improve provider medical records, HEDIS documentation, and service delivery to members.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable policies; maintain confidentiality.
Travel as needed for local travel and onsite activities.
Qualifications
Required: Associate degree or 3 years of additional experience in lieu of degree
Required: LVN/LPN with HEDIS experience and 3-4 years clinical experience
Bachelor Degree preferred
Knowledge of medical terminology, standard medical practices, medical coding or data management; knowledge of Microsoft applications (Excel and Access)
RN with relevant experience may be considered
Benefits All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, disability coverage, life insurance, and other voluntary benefits. Wellness programs and other employee perks are offered.
About Presbyterian Healthcare Services Presbyterian exists to ensure patients, members and communities receive their best health. We are a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. We were founded in New Mexico in 1908 and are the state’s largest private employer with nearly 14,000 employees. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Centennial Care Medicaid, and Commercial plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses.
Maximum Offer for this position is up to $37.58/Hr. Compensation includes a range that reflects experience, training, internal equity, and organizational needs.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Industries: Hospitals and Health Care
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Base pay range $24.62/hr - $37.58/hr
Why Join Us Presbyterian is dedicated to improving people’s lives — the lives of our patients and coworkers. We are locally owned and operated, with supportive leadership that empowers employees and opportunities to grow from entry-level to senior positions.
Responsibilities
Uses Performance Improvement tools to develop work plans, tasks, timelines, and measurements for health management projects; plan milestones and monitor progress.
Identify needs, design data collection tools, analyze data and claims, provide feedback, and monitor outcomes and quality of services.
Perform Medical Record Reviews to support quality initiatives and regulatory reporting (HEDIS, CMS Star measures, FEHB, Medicaid, supplemental data); manage productivity and over-read standards as applicable.
Manage an assigned caseload of provider locations; provide verbal and written progress on provider submissions for requested medical records; communicate effectively with providers.
Identify, analyze, and collect clinical information for HEDIS/NCQA requirements; document findings in HEDIS database tools; track issues and outcomes related to abstractions and over-reads.
Integrate data from electronic and paper sources; communicate significant findings to management in a timely manner.
Auditing to ensure data abstraction accuracy; mentor abstractors to improve skills; assist in site visits and on-site medical record abstraction as needed.
Handle record requests via appropriate methods (fax, email, mail, site visits) and convert files to usable formats; ensure proper file naming and storage on shared drives.
Follow HEDIS Technical Specifications to obtain and evaluate medical record documentation for HEDIS measures.
Assist in developing criteria for medical record and site reviews; contribute to educational and training materials.
Identify barriers and plan interventions to improve provider medical records, HEDIS documentation, and service delivery to members.
Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies, and other applicable policies; maintain confidentiality.
Travel as needed for local travel and onsite activities.
Qualifications
Required: Associate degree or 3 years of additional experience in lieu of degree
Required: LVN/LPN with HEDIS experience and 3-4 years clinical experience
Bachelor Degree preferred
Knowledge of medical terminology, standard medical practices, medical coding or data management; knowledge of Microsoft applications (Excel and Access)
RN with relevant experience may be considered
Benefits All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, disability coverage, life insurance, and other voluntary benefits. Wellness programs and other employee perks are offered.
About Presbyterian Healthcare Services Presbyterian exists to ensure patients, members and communities receive their best health. We are a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. We were founded in New Mexico in 1908 and are the state’s largest private employer with nearly 14,000 employees. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Centennial Care Medicaid, and Commercial plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses.
Maximum Offer for this position is up to $37.58/Hr. Compensation includes a range that reflects experience, training, internal equity, and organizational needs.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Industries: Hospitals and Health Care
#J-18808-Ljbffr