HEDIS Specialist I

SHIFT TIMES 8:00 AM TO 5:00 PM MONDAY TO FRIDAY, SOME OT MIGHT BE REQUIRED AVERAGE OF 10-15 DURING PROJECT. LOCATION: HOUSTON, TX 77084 Duties Medical records retrieval, naming charts, uploading charts, cleaning up medical records and going to other sites (doctor offices) to retrieve medical records. Contacting provider offices to request records, naming records based off of spreadsheet. Experience with EMR systems, medical records, and at least one-year HEDIS experience. Microsoft Office - Word, Excel and Outlook (intermediate level, data entry). Microsoft Office knowledge. Will be able to expense for mileage. Time management. Communication. Multi-tasking. Summary Under the direction of the HEDIS Program Manager, supports the annual HEDIS project management by coordinating the identification, collection, and abstraction of medical records and other data in collaboration with other HEDIS staff. Essential Functions Assists the Manager in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review. Participates in meetings with vendors for the medical record collection process. Assists Manager with medical record vendor oversight. Assists Manager in training abstractor staff and participates in the medical record IRR. Identifies member service gaps based on data loaded into the HEDIS application. Collects medical records and reports from provider offices based on member needed services reports and gaps and loads data into the HEDIS application. Works with the corporate HEDIS team to monitor the accuracy of abstracted records as required by HEDIS specifications. Participates in scheduled meetings with the corporate HEDIS team, vendors, and HEDIS auditors. Assists the QI staff with physician and member interventions and incentive efforts as needed. Provides data collection and report development support for Quality Improvement studies and performance improvement projects. Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS, and state audits. Qualifications Knowledge/Skills/Abilities: Proficient with PC-based systems and the ability to learn new information systems and software programs. Ability to work with large files and data sets. Basic understanding of Health Plan billing practices and information systems. Strong communication and teaming/interpersonal skills; strong leadership capabilities. Ability to initiate and maintain cross-team relationships. Excellent verbal and written communication skills. Ability to abide by policies. Maintain regular attendance based on the agreed-upon schedule. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers. Required Education State Licensed Vocational Nurse or Registered Health Information Technician (RHIT), or Certified Medical Record Technician with training in coding procedures. Required. Experience 0-2 years coding and medical record abstraction experience. 0-2 years managed care experience. Basic knowledge of HEDIS and NCQA. Licensure/Certification is a plus. Registered Health Information Technician (RHIT), or Certified Medical Record Technicians. Additional Information 0-2 years coding and medical record abstraction experience. 0-2 years managed care experience. Basic knowledge of HEDIS and NCQA. Licensure/Certification is a plus. #J-18808-Ljbffr