Hedis Coordinator

1 week ago

Louisville, United States Spectraforce Technologies Full time
Title: HEDIS Coordinator
Duration: 06 Months (Potential to extend)
Location: Louisville, KY 40223
Shift: 7 am-7 pm (8 hours within a time zone that with some flexibility)
Responsibilities:
  • Retrieval/Pursuit contractors will be working on the collection of charts, contact/coordination with providers either through phone/fax/email or EMR avenues. May use various portals to obtain medical records. Will be responsible for upload, combining, reviewing (quality checking) and ensuring that all documentation is received and noted in the system. May be asked to go onsite to retrieve records (very minimally) They will be coordinated from a FTE to ensure and the FTE will review quality and set up productivity standards. Contractors will also be expected to be inter-reliability reviewed (IRR) and complete testing for measures that they are pulling.
  • Abstracting/Research/Overread Contractors will be reviewing any medical records at different intervals in the project. In supplemental will be abstracting the chart for medical record compliance. Productivity and quality standards will be reviewed continuously. Expectation will be to complete testing for measures at 100% for at least 4 measures. Abstraction will be expected to maintain productivity at 35 charts per day (min) and 95% overall quality score. Research will be reviewing all charts that continue to be non-compliant for any measure that they are approved for. Will be looking various claims systems and other items to close gaps. Overread will be responsible for non-compliant and compliant overread for quality control in both hybrid and supplemental. Must be extremely detail oriented.
  • Ability to shift responsibilities and be a ‘team player‘ is strongly recommended.
  • Retrieval/Pursuit - 90% retrieval rate; 2 day TAT with chart consolidation and upload, Abstracting - 35 charts per day/95% overall quality score; Research - 25 research activities per day; Overread 40 charts per day/95% quality score
Internal/External Groups with which the Candidate will interface: Required Skills/Experience: Preferred Skills/ Experience: 1.MS Teams exposure1.Detail Oriented2. Some form of HEDIS knowledge2.Working knowledge of QSHR3.Excel3.Technical Specification exposureEducation Requirement:HS DiplomaEducation Preferred: Software Skills Required:MS Office Suite - including Word, ExcelRequired Certifications: Required Testing:Measure testing

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