HEDIS Medical Record Collector

Molina HEDIS/Quality Improvement Medical Records Collector

Molina's HEDIS/Quality Improvement Medical Records Collector will work collaboratively in outreaching to providers in order to pursue medical records via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up, for the HEDIS projects.

• Under the direction of the national and/or regional lead, the Medical Records Collector supports the annual HEDIS audit and other HEDIS like audits, by organizing provider outreach, pursuit, collection and upload of provider medical records into the internal database.

• Assisting with project management by coordinating the identification, pursuit and collection of medical records and other data in collaboration with other HEDIS staff.

• Assists the Manager and Supervisor(s) and / or performs the coordination and preparation of the HEDIS medical record collection process that includes the pursuit via phone call, fax, mail, electronic medical record system retrieval and direct onsite pick up.

• Participates in meetings with vendors for the medical record collection process.

• Collects medical records and reports from provider offices, loads data into the HEDIS application. Onsite Medical record collection may be required for all staff.

Must Have Skills:

• Must have HEDIS/Quality knowledge, understand medical record retrieval, knowledge with EMR system.
• Understanding HIPAA Regulations and handle PHI Securely.
• Excellent customer service and active listening skills.
• Proficiency with data analysis tools (e.g., Excel).
• Ability to manage files, schedules and information efficiently.
• Ability to effectively interface with staff, clinicians, and leadership.
• Strong prioritization skills and detail orientation.
• Strong verbal and written communication skills, including professional phone etiquette.
• Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.

Day to Day Responsibilities:

• Conducts outreach to provider offices via phone, fax, mail, electronic medical record (EMR) systems, and direct onsite retrieval to collect medical records.
• Identifies chase targets and prioritizes provider lists daily to ensure timely record retrieval.
• Documents detailed outreach notes and call attempts in tracking systems.
• Tracks incoming medical records, ensures records are complete, and appropriately renames and organizes files according to established guidelines.
• Resends follow-up requests as needed to ensure timely receipt of outstanding records.
• Uploads and processes medical records and supporting reports into the Healthcare Effectiveness Data and Information Set (HEDIS) application and internal databases.
• Coordinates with medical record vendors, as needed, to support retrieval efforts.
• Reviews returned records for completeness and accuracy prior to submission.
• Identifies challenging or non-responsive provider locations and escalates barriers appropriately.
• Supports the annual HEDIS audit and other regulatory audits by coordinating outreach, managing pursuit efforts, and ensuring accurate documentation and submission of records.
• Provides project coordination support to leadership by assisting with identification, tracking, pursuit, and collection of medical records and required documentation in collaboration with HEDIS team members.
• Participates in meetings with vendors related to the medical record collection process.
• Travels, as needed, to provider offices for onsite medical record retrieval.