Medical Records Reviewer

Overview

Provides ongoing HEDIS/QARR/Risk Adjustment medical record collection and abstraction, as well as the collection of records related to Quality Management and Risk Adjustment initiatives. Responsible for clinical audits needed across products. Provides accurate assessment of provider performance against HEDIS/QARR standards and procedures. Adheres to HIPAA confidentiality requirements for protected health information. Works under general supervision.

What We Provide

• Referral bonus opportunities

• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability

• Employer-matched retirement saving funds

• Personal and financial wellness programs

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

• Generous tuition reimbursement for qualifying degrees

• Opportunities for professional growth and career advancement

• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Interacts directly with provider offices, clinics, and other healthcare facilities on the retrieval of medical records for review and abstraction pertaining to HEDIS/QARR/Risk Adjustment and other focused audits/studies. Provides guidance on protocol as required.

• Schedules and performs onsite medical record reviews with high volume providers for compliance with HEDIS/QARR/Risk Adjustment standards.

• Manages and organizes scanned medical records in a central repository inclusive of performing data entry, scanning relevant components of the medical record to support reviews performed, and using appropriate naming convention.

• Safeguards confidentiality of the medical charts/records and complies with all local, state, and federal laws pertaining to medical records. Assures compliance with all HIPAA regulations concerning use, retrieval, storage, and sharing of medical records.

• Educates providers and office staff on HEDIS/QARR quality metrics, Risk Adjustment specifications, and medical record review criteria.

• Participates in required trainings. Participates and assist in quality improvement audits, Risk Adjustment Data Validation (RADV) and other Risk Adjustment surveys and focused studies.

• Maintains a comprehensive understanding of the QM and Risk Adjustment (RA) policies and procedures and ensure compliance.

• Accesses scanned copies of medical records in appointed vendor tool or from Client's VPN directory.

• Follows up on all outstanding issues found during medical record review. This includes initiation and completion of chart issues.

• Accesses EMR's to get pertinent information.

Qualifications

Education:

• Associate's Degree in Nursing, Health Care Administration, Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coder, Allied Health professional or other health related field required

Work Experience:

• Minimum two year experience in medical record retrieval and review required or

• Quality Management Only:

• Minimum of one year quality improvement experience in Medicare, Medicaid or Commercial Health Plan Knowledge of HEDIS/QARR standards, medical terminology, strong computer and organizational skills required

• Ability to evaluate medical records with attention to detail required

• Ability to use databases and prepare reports as needed required

• Ability to multitask and troubleshoot problems independently. required

• Effective oral and written communication and interpersonal skills required

• Proficient in personal computer, preferably Microsoft Windows Word, PowerPoint, Excel and Access required

Pay Range

USD $28.09 - USD $35.08 /Hr.
About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.