Apidel Technologies
Duties:
Maintain knowledge of medical record review and EMR systems.
Maintain up-to-date knowledge of HEDIS, QARR and Star specifications
Distribute requests for records and schedules appointments with provider offices ensure timely completion of duties meet internal and regulatory standards and requirements.
Perform clinical audits via EMR, in-house paper medical records, on-site provider visits measure compliance with preventive health guidelines and measure effectiveness of quality improvement initiatives.
Identify, track and report variation from standards of care by audit of core operations, patient care processes and medical record documentation. Designs interventions drive improvement and minimize variation from standards of care.
Data enter accurate and timely clinical quality findings in the appropriate system(s) in accordance with established documentation standards for Metro Plus Health Plan ensure integrity of member services provided over the continuum of care and over time.
Assist in implementation of quality improvement activities as directed by Quality Management programming needs. Support interdepartmental and internal teams focused on process improvement projects and outcomes.
Provide educational support physicians and staff ensure process improvement and increase member satisfaction, member retention, continuity of care and drive HEDIS and QARR improvement activities.
Facilitate retrieval of medical record documentation and work with provider group(s) and in-field navigators retrieve electronic and paper records that supports HEDIS/QARR.
Records findings of patient encounters include patient identifiers, relevant information and results in database.
Participate in the annual HEDIS and QARR hybrid medical record review project:
Work with provider offices facilitate request and review of charts
Supports temporary staff in the review of medical records (electronic and paper-based)
Serve as a final reviewer of HEDIS and QARR records
Skills:
Clinical background: Health Educator, RN, LPN, RN, LMSW or LCSW, Foreign Medical Graduate (FMG) with a minimum of three years relevant work experience.
Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
3 5 years in Quality Improvement in a health care and/or Managed Care setting strongly preferred.
Ability travel within the Metro Plus service area.
Knowledge of HEDIS and QARR specifications.
Experience using EMR systems, e.g. EPIC, Quadramed.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
Knowledge of ICD-10 and CPT codes preferred.
Ability proficiently read and interpret medical records; Ability measure compliance and identify deficiencies in chart documentation against standards.
Education:
High School/GED with a minimum of years HEDIS review experience. Clinical background preferred (Medical Assistant, Nursing Assistant, Health Educator, LPN, RN, LMSW or LCSW.
Experience with medical record review working on HEDIS/QARR in a managed care, health plan or provider office setting.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
Schedule Notes:
Shift Time: 9:00AM -5:00PM In person/Hybrid: Field Job Requirements:
Maintain knowledge of medical record review and EMR systems.
Maintain up-to-date knowledge of HEDIS, QARR and Star specifications
Distribute requests for records and schedules appointments with provider offices ensure timely completion of duties meet internal and regulatory standards and requirements.
Perform clinical audits via EMR, in-house paper medical records, on-site provider visits collect documentation of measure compliance.
Data enter accurate and timely findings in the appropriate system(s) in accordance with established documentation standards for Metro Plus Health Plan ensure integrity of member services provided over the continuum of care and over time.
Preferred skills
HEDIS Quality Reviewer
Maintain knowledge of medical record review and EMR systems.
Maintain up-to-date knowledge of HEDIS, QARR and Star specifications
Distribute requests for records and schedules appointments with provider offices ensure timely completion of duties meet internal and regulatory standards and requirements.
Perform clinical audits via EMR, in-house paper medical records, on-site provider visits measure compliance with preventive health guidelines and measure effectiveness of quality improvement initiatives.
Identify, track and report variation from standards of care by audit of core operations, patient care processes and medical record documentation. Designs interventions drive improvement and minimize variation from standards of care.
Data enter accurate and timely clinical quality findings in the appropriate system(s) in accordance with established documentation standards for Metro Plus Health Plan ensure integrity of member services provided over the continuum of care and over time.
Assist in implementation of quality improvement activities as directed by Quality Management programming needs. Support interdepartmental and internal teams focused on process improvement projects and outcomes.
Provide educational support physicians and staff ensure process improvement and increase member satisfaction, member retention, continuity of care and drive HEDIS and QARR improvement activities.
Facilitate retrieval of medical record documentation and work with provider group(s) and in-field navigators retrieve electronic and paper records that supports HEDIS/QARR.
Records findings of patient encounters include patient identifiers, relevant information and results in database.
Participate in the annual HEDIS and QARR hybrid medical record review project:
Work with provider offices facilitate request and review of charts
Supports temporary staff in the review of medical records (electronic and paper-based)
Serve as a final reviewer of HEDIS and QARR records
Skills:
Clinical background: Health Educator, RN, LPN, RN, LMSW or LCSW, Foreign Medical Graduate (FMG) with a minimum of three years relevant work experience.
Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting.
3 5 years in Quality Improvement in a health care and/or Managed Care setting strongly preferred.
Ability travel within the Metro Plus service area.
Knowledge of HEDIS and QARR specifications.
Experience using EMR systems, e.g. EPIC, Quadramed.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
Knowledge of ICD-10 and CPT codes preferred.
Ability proficiently read and interpret medical records; Ability measure compliance and identify deficiencies in chart documentation against standards.
Education:
High School/GED with a minimum of years HEDIS review experience. Clinical background preferred (Medical Assistant, Nursing Assistant, Health Educator, LPN, RN, LMSW or LCSW.
Experience with medical record review working on HEDIS/QARR in a managed care, health plan or provider office setting.
Proficient in Microsoft Office applications including Word, Excel, PowerPoint and Access.
Schedule Notes:
Shift Time: 9:00AM -5:00PM In person/Hybrid: Field Job Requirements:
Maintain knowledge of medical record review and EMR systems.
Maintain up-to-date knowledge of HEDIS, QARR and Star specifications
Distribute requests for records and schedules appointments with provider offices ensure timely completion of duties meet internal and regulatory standards and requirements.
Perform clinical audits via EMR, in-house paper medical records, on-site provider visits collect documentation of measure compliance.
Data enter accurate and timely findings in the appropriate system(s) in accordance with established documentation standards for Metro Plus Health Plan ensure integrity of member services provided over the continuum of care and over time.
Preferred skills
HEDIS Quality Reviewer