TalTeam
Health Services - Nurse, Clinical Medical Review
TalTeam, Baltimore, Maryland, United States, 21276
Overview
PURPOSE: The Clinical Medical Review Specialist (a professional with clinical experience) will report to the Clinical Support Supervisor HEDIS and be part of the Quality Team. The main duties include chart retrieval, using proprietary tools and software to conduct thorough medical record reviews in line with NCQA specifications, retrieval follow-up, and escalating issues as needed. Main duties will be assigned according to experience, knowledge, skills, and abilities. This role requires extensive knowledge of HEDIS measures to accurately and expediently abstract medical records, all while adhering to HIPAA Privacy and Security standards. Additional tasks involve helping with EMR Medical Record Retrieval for HEDIS, contacting provider offices to request or validate facility and provider contact information and record retrieval preference, and/or requesting medical records for the HEDIS project and supporting other needs within the Quality Department. Essential Functions
Abstractor Primary functions: 10% Call provider offices to request or validate facility/provider contact information specifically for HEDIS medical record retrieval. Document all outreach efforts. 20% Retrieve medical records via EMR that meet HEDIS requirements and ensure compliance with HIPAA. Upload charts to abstraction platform upon receipt. 40% Use extensive knowledge of HEDIS measures to facilitate accurate and efficient data abstraction from charts within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines. 20% Use various software applications to support HEDIS operations by creating and researching clinical and retrieval pends. 10% Other duties as assigned (see "additional functions" below). Additional functions
Overreading (may Replace The Abstraction Function)
Accurately and efficiently over-read medical record abstractions (as performed by the HEDIS abstraction staff) within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines. Correct errors identified through the over-read process, including a re-review of charts that may contain similar errors. Identify and report abstraction errors and provide measure re-education with the abstractor. Risk Adjustment
Risk Adjustment
Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-season. Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Education Level: Bachelors degree in nursing, associates degree in nursing, diploma in nursing Education Details: Registered Health Information Associate/Registered Health Information Technician, or a related field Experience: 3 years clinical experience and 5 years HEDIS experience. We are seeking a qualified RN/LPN with experience in the payer/health insurance side of HEDIS reporting abstraction processes. The ideal candidate will have a robust understanding of healthcare (NCQA) quality metrics and a proven track record of accurate data abstraction and interpretation. Prior experience in HEDIS abstraction of medical records for gap closure within the health plan setting or prior experience with a HEDIS vendor (e.g. Reveleer, Cotiviti, Inovalon) is essential for this role. Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy. Proficient skills and experience using Microsoft Office (Excel, Word, Power Point, etc.), Microsoft Teams and Outlook are required. Experience utilizing various EMR platforms including Epic, eClinical Works, Athena, Cerner, All Scripts, and Tebra to retrieve medical records is essential for this role. Proven HEDIS overreading experience for a health plan or HEDIS vendor is a bonus. Required Skills
Current knowledge of clinical practices related to HEDIS and Medical Record Review Strong organizational skills, ability to prioritize responsibilities with attention to detail and able to be flexible in shifting tasks as needed Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology Must possess excellent verbal and written communication skills. Strong interpersonal skills. Ability to work independently, as well as a member of a team Talteam Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
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PURPOSE: The Clinical Medical Review Specialist (a professional with clinical experience) will report to the Clinical Support Supervisor HEDIS and be part of the Quality Team. The main duties include chart retrieval, using proprietary tools and software to conduct thorough medical record reviews in line with NCQA specifications, retrieval follow-up, and escalating issues as needed. Main duties will be assigned according to experience, knowledge, skills, and abilities. This role requires extensive knowledge of HEDIS measures to accurately and expediently abstract medical records, all while adhering to HIPAA Privacy and Security standards. Additional tasks involve helping with EMR Medical Record Retrieval for HEDIS, contacting provider offices to request or validate facility and provider contact information and record retrieval preference, and/or requesting medical records for the HEDIS project and supporting other needs within the Quality Department. Essential Functions
Abstractor Primary functions: 10% Call provider offices to request or validate facility/provider contact information specifically for HEDIS medical record retrieval. Document all outreach efforts. 20% Retrieve medical records via EMR that meet HEDIS requirements and ensure compliance with HIPAA. Upload charts to abstraction platform upon receipt. 40% Use extensive knowledge of HEDIS measures to facilitate accurate and efficient data abstraction from charts within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines. 20% Use various software applications to support HEDIS operations by creating and researching clinical and retrieval pends. 10% Other duties as assigned (see "additional functions" below). Additional functions
Overreading (may Replace The Abstraction Function)
Accurately and efficiently over-read medical record abstractions (as performed by the HEDIS abstraction staff) within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines. Correct errors identified through the over-read process, including a re-review of charts that may contain similar errors. Identify and report abstraction errors and provide measure re-education with the abstractor. Risk Adjustment
Risk Adjustment
Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-season. Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Education Level: Bachelors degree in nursing, associates degree in nursing, diploma in nursing Education Details: Registered Health Information Associate/Registered Health Information Technician, or a related field Experience: 3 years clinical experience and 5 years HEDIS experience. We are seeking a qualified RN/LPN with experience in the payer/health insurance side of HEDIS reporting abstraction processes. The ideal candidate will have a robust understanding of healthcare (NCQA) quality metrics and a proven track record of accurate data abstraction and interpretation. Prior experience in HEDIS abstraction of medical records for gap closure within the health plan setting or prior experience with a HEDIS vendor (e.g. Reveleer, Cotiviti, Inovalon) is essential for this role. Applicants must be detail-oriented and able to work independently while maintaining a high level of accuracy. Proficient skills and experience using Microsoft Office (Excel, Word, Power Point, etc.), Microsoft Teams and Outlook are required. Experience utilizing various EMR platforms including Epic, eClinical Works, Athena, Cerner, All Scripts, and Tebra to retrieve medical records is essential for this role. Proven HEDIS overreading experience for a health plan or HEDIS vendor is a bonus. Required Skills
Current knowledge of clinical practices related to HEDIS and Medical Record Review Strong organizational skills, ability to prioritize responsibilities with attention to detail and able to be flexible in shifting tasks as needed Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology Must possess excellent verbal and written communication skills. Strong interpersonal skills. Ability to work independently, as well as a member of a team Talteam Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
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