Job Description

Duties

Under the direction of the Manager of Medical Record Review Operations, the HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO) with duties including but not limited to the following:

• Coordination of the medical records identification process, collection activities and review.
• Performing and applying structured auditing abstraction criteria to medical records to determine compliance.
• Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.
• Developing and maintaining expertise in the requirements and parameters of mandated HEDIS and State performance measures.
• Completing medical record review abstraction and overread and providing feedback for medical records that do not meet the HEDIS or State Measure Technical Specifications criteria within a live software environment.
• Providing clinical and administrative support to providers as directed.
• Maintaining productivity level of a minimum of chases/charts per defined period according to policy.
• Maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.
• Assisting in the medical record collection process including making phone calls, sending out faxes/letters or chart retrieval requests to providers as assigned.
• Completing additional designated projects assigned and deemed as necessary."

Skills:

• Three to five years working with HEDIS data including chart review/collection. HEDIS, QRS, or STARs experience. Knowledge of medical terminology and basic charting to include diabetic labs, HPV testing, preventive health screenings, immunization and well-care terminology for children, adults and pregnant women.
• Understanding of current HEDIS Technical Specifications.
• Knowledgeable in the HEDIS audit process (PSV, CSV and MRRV).
• Proficiency in Excel, Word, Power Point and Outlook.
• Experience with medical record abstraction tool(s) and wiliness to learn any medical record abstraction tool.
• Experience in the Pediatric, Maternity, Diabetic or Provider Office Setting.
• Familiar with the Cancer Registry.
• Familiar with Bright Futures.
• Strong written and oral communication skills, critical thinking skills, strong organizational skills.
• Able to think and work independently, effectively, and under pressure of deadlines."

Education:

• Associates Degree, RN, LPN, or relevant work experience

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