Temporary Hedis Abstraction & Review Specialist

011370 CCA-Population Health Strategy

Position Summary:

Reporting to the Manager of HEDIS or her/his delegate, the HEDIS Abstraction & Review Specialist will support quality controls for the HEDIS Medical Record Review. HEDIS ratings are one tool used to assess Commonwealth Care Alliance's performance in a set of clinical effectiveness measures and directly contributes to the plan's achievement of quality incentives such as the Medicare Star Rating system and the recovery of the Quality Withhold.

Major responsibilities of this position include completing overreads of completed medical record reviews, contacting and working with contracted provider sites and facilities to request member medical records, retrieve the relevant medical record documentation in accordance with the current technical specifications of the HEDIS measure set, and data entry of findings in the medical record data management system.

This is a temporary position for employment between the months of December and June; hours/week to be determined, and specific days of employment are flexible.

Supervision Exercised:

• No, this position does not have direct reports.

Essential Duties & Responsibilities:

• Effectively develop, enhance and maintain provider clinical relationships to obtain access to medical record data.

• Collect, abstract and review medical record data and identify needed improvements that impact HEDIS measures (i.e., identify deficiencies in data capture) and recommend strategies designed to improve all aspects of the medical record data abstraction and review process.

• Contact provider offices and primary care sites to request medical record documentation, and facilitate the collection of medical record data.

• Perform onsite collection of medical record data according to the measure's specifications and comply with provider site and facility policies and procedures for scheduling, requesting, and reviewing records during an onsite visit.

• Perform remote collection of relevant medical record documentation according to the measure's current HEDIS Technical Specifications and comply with the applicable policies and procedures to obtain, retain and terminate remote access.

• Maintain a system to organize medical records and other materials or resources which are required for the effective flow of the medical record review process.

• Track the progress of the medical record requests, and follow up with sites and facilities, as deemed appropriate, to ensure that all requests for medical record documentation are fulfilled.

• Document medical record data abstraction findings in the CCA HEDIS medical record data management system following the requirements outlined in the measure's current HEDIS Technical Specifications.

• Participate in the quality assurance and inter-rater reliability process and maintain a 95% accuracy rate throughout the entirety of the project.

• Communicate all significant findings and project issues to the Program Manager of Quality Measurement and Reporting in a timely manner.

Working Conditions:

• Standard office conditions.

Required Education (must have):

• Bachelor's Degree or equivalent experience

Desired Licensing (nice to have):

• Current unrestricted RN license in the Commonwealth of Massachusetts preferred

MA Health Enrollment (required if licensed in Massachusetts):

• No, this is not required for the job.

Required Experience (must have):

• 2+ years Clinical Quality experience (prefer managed care setting)

• Previous medical record/chart review experience required

• Electronic Medical Records (EMR) experience

Desired Experience (nice to have):

• Previous HEDIS data collection experience highly preferred

• Medical Record Audit experience preferred (medical record review and capturing/ documenting appropriate clinical information needed to assure compliance)

• Managed care/Health plan experience preferred

Required Knowledge, Skills & Abilities (must have):

• Familiarity with HEDIS specifications and guidelines

• Ability to read and navigate clinical medical records

• Must be self-motivated and able to learn new computer software quickly

• Must be comfortable and proficient in being trained on data collection software that allows collection and record of medical record information accurately on a timely basis.

• Ability to complete medical record review using electronic systems

• Skilled in use of computers including MS Windows, Excel, Word, and PowerPoint

• Strong interpersonal skills, verbal and written skills

• Strong project management skills

• Ability to work independently and as part of a team

• Ability to perform duties with accuracy and attention to detail

Required Language (must have):

• English

Desired Knowledge, Skills, Abilities & Language (nice to have):

• Bilingual English/Spanish preferred

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.