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Clinical Data Analyst

2 months ago

New York, New York, United States Pride Health Full time
About the Role

Pride Health is seeking a highly skilled Medical Records Specialist to join our team as a HEDIS Quality Reviewer. In this role, you will be responsible for maintaining knowledge of medical record review and EMR systems, as well as up-to-date knowledge of HEDIS, QARR, and Star specifications.

Key Responsibilities
  • 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 schedule 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. Design 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.
  • Record 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.
    • Support temporary staff in the review of medical records (electronic and paper-based).
    • Serve as a final reviewer of HEDIS and QARR records.
Requirements
  • 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 healthcare 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.