HEDIS Quality Reviewer

Found in: Lensa US P 2 C2 - 2 weeks ago

Jamaica, United States LanceSoft Full time
Enter Job Description...
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.
Data enter accurate and timely clinical quality findings in the appropriate system(s) in accordance with established documentation standards for MetroPlus Health Plan to ensure integrity of member services provided over the continuum of care and over time.
ssist 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

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Diversity, Equality, and Inclusivity This means a deep commitment to each other equally, in an open, diversified team environment. We strive to be as diverse as the clients and employees we partner with. We embrace people of any race, ethnicity, national origin, religion, gender identity, and sexual orientation. LanceSoft is a certified Minority Business Enterprise (MBE).
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