POPULATION HEALTH COMPLIANCE TECHNICIAN

Job Title

Provides ongoing VBS/HEDIS medical record collection and abstraction; and supports the abstraction of medical records related to VBS/HEDIS Compliance initiatives. Provides accurate assessment of provider performance against VBS/HEDIS standards and procedures. Adheres to strict HIPAA confidentiality requirements for protected health information. Works under general supervision.

Position Requirements / Qualifications

Education/Experience: Graduate from a Standard High School or GED Equivalent. Graduate from an approved Medical Coding Program, Medical Assisting program preferred.

Licensure / Certification: Maintain current CPR certification from the American Heart Association. MA certification or coding certification desired.

Skills / Ability: Medical Terminology, Keyboard, Knowledge of Medicare, Medicaid, and Managed Care coverage benefits/limitations, NCQA HEDIS requirements. Knowledge of ICD9 and CPT Coding. Basic computer knowledge is preferred. Bilingual in English/Spanish preferred.

Position Responsibilities (This Is A Non-Exempt Position):

Performing accurate and comprehensive reviews of medical records for HEDIS measures.

Auditing high volumes of medical records to ensure correct and appropriate code assignment.

Ability to multitask and troubleshoot problems independently.

Ensuring accurate data entry for claim submission.

Medical record review, data abstraction, and quality experience.

Schedule appointments with health care provider including appointments to PCP for their health risk assessments, preventative visits and chronic care management.

Participate in Performance Improvement Activities.

Participate in appropriate continuing education in service training.

Maintain current licensure and/or certificates.

Ability to read and interpret medical documents.

Ability to prioritize, multi-task, and achieve goals on time; work independently and to self-motivate.

Strong data entry skills; capable of using a computer efficiently and effectively.

Able to navigate and master practice management and EHR software programs.

Treat clients, team members and the public with courtesy, respect and present a positive public image.

High production environment and, candidates must adhere to measured productivity requirements.

Ensuring adherence to NCQA HEDIS guidelines.

Research medical history to determine the most appropriate and source of necessary documentation.

Based on a strong knowledge of HEDIS criteria, identify the medical information that supports the specific HEDIS measure.

Responsible for obtaining, organizing, and securing a large volume of medical records within a limited timeframe.

Adhere to department Policies and Procedures in performing duties and assignments.

Demonstrates the ability to work with a diverse population.

Ability to post appropriate CPT Category II Performance Measure codes after chart review and audit.

Reports to work on time and ready to work with minimal absenteeism.

Adheres to Confidentiality Policies and Procedures / HIPAA Regulations.

Well organized with the ability to maintain attention to detail.

Ability to work independently and as a team member.

Maintains productivity standard of reviewing 60 medical records daily.

Performs other duties as assigned.