We're looking for HEDIS Quality Reviewer for our client with a leading hospital in New York, NY.
Please find below details of the position.
Position: HEDIS Quality Reviewer - Hybrid Position
Location: New York, NY
Duration: 2 months contract with extension possibilities.
Shift: 9-5 Hybrid
Pay - $40/hr
Job 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 to ensure timely completion of duties to meet internal and regulatory standards and requirements.
• Perform clinical audits via EMR, in-house paper medical records, on-site provider visits to measure compliance with preventive health guidelines and to 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 to drive improvement and minimize variation from standards of care.
• 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 to physicians and staff to 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 to retrieve electronic and paper records that supports HEDIS/QARR.
• Records findings of patient encounters to 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 to 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.
• 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 to proficiently read and interpret medical records; Ability to measure compliance and identify deficiencies in chart documentation against standards.
Education:
High School/GED with a minimum of two 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.
