Senior Abstractor, National HEDIS/Quality Improvement (Remote)

Job Title

Provides senior level support for Molina enterprise quality improvement abstraction activities.

Job Description

Provides senior level support for Molina enterprise quality improvement abstraction activities. Responsible for data collection and abstraction of medical records for Healthcare Effectiveness Data and Information Set (HEDIS) and HEDIS-like initiatives and compliance, and supplemental data collection activities. Meets chart abstraction productivity standards and minimum over read standards.

Essential Job Duties

Facilitates HEDIS medical record review, including ongoing review of records submitted by providers and the annual HEDIS medical record review process. Participates in meetings with the national overread team, national quality training team, the regional HEDIS team, vendors and HEDIS auditors for quality/HEDIS review activities to coordinate medical records and quality-related initiatives. Participates in meetings with vendors to enable the medical records collection process. As needed, may collect medical records and reports from provider offices, load data into the HEDIS application, and compare documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed. Assists with quality projects and process improvement initiatives. Provides mentorship and training to new and existing quality abstraction team members.

Required Qualifications

At least 3 years of experience in a health care quality/HEDIS-specific setting, and experience with medical record review and abstraction, or equivalent combination of relevant education and experience. Intermediate knowledge and understanding of HEDIS and NCQA. Critical thinking, problem-solving, and analytical skills. Attention to detail and organizational skills, with a focus on accuracy and consistency. Ability to work independently in a fast-paced, deadline-driven environment. Effective verbal and written communication skills. Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

Managed care experience. Experience with HEDIS audits (including but not limited to chart collection, project management, etc.). Advanced knowledge related to HEDIS and National Committee for Quality Assurance (NCQA). Registered Nurse (RN). If licensed, licensed must be active and unrestricted in state of practice.

Job Info

Job Identification 2038223

Job Category Quality & Risk Adjustment

Job Schedule Full time

Locations 200 Oceangate, Long Beach, CA, 90802, US

Salary Range $19.64 - $42.55 ~Hourly *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.