HEDIS Quality Reviewer
: Job Details :

Weekly Pay Range - $1511 To $1678 Job Title: HEDIS Quality Reviewer Job Specialty: Quality Management Job Duration: 9 months Shift: Day - 9 am to 5 pm, Hybrid Guaranteed Hours: 40 hours per week Experience: - 3 to 5 years in Quality Improvement in a healthcare and/or Managed Care setting - Clinical background preferred (Health Educator, RN, LPN, LMSW, LCSW, or Foreign Medical Graduate with a minimum of three years of relevant work experience) - Experience with medical record review working on HEDIS/QARR in a managed care or health plan setting License: Not specified Certifications: Not specified Must-Have: - Ability to travel within the service area - Knowledge of HEDIS and QARR specifications - Experience using EMR systems, e.g., EPIC, Quadramed - Proficient in Microsoft Office applications including Word, Excel, PowerPoint, and Access - Knowledge of ICD-10 and CPT codes preferred - Ability to read and interpret medical records proficiently - Ability to measure compliance and identify deficiencies in chart documentation Job Description: - Maintain knowledge of medical record review and EMR systems - Stay up-to-date with HEDIS, QARR, and Star specifications - Distribute requests for records and schedule appointments with provider offices to ensure timely completion of duties - Perform clinical audits via EMR, in-house paper medical records, on-site provider visits to measure compliance with preventive health guidelines - Measure effectiveness of quality improvement initiatives - Identify, track, and report variations from standards of care by auditing core operations, patient care processes, and medical record documentation - Design interventions to drive improvement and minimize variations from standards of care - Enter accurate and timely clinical quality findings in appropriate systems - Assist in the implementation of quality improvement activities as directed by Quality Management programming needs - Support interdepartmental and internal teams focused on process improvement projects and outcomes - Provide educational support to physicians and staff to ensure process improvement, increase member satisfaction, retention, continuity of care, and drive HEDIS and QARR improvement activities - Facilitate retrieval of medical record documentation and work with provider groups and in-field navigators to retrieve electronic and paper records supporting HEDIS/QARR - Record findings of patient encounters, including patient identifiers, relevant information, and results in the database - Participate in the annual HEDIS and QARR hybrid medical record review project, working with provider offices to facilitate requests and reviews of charts - Support temporary staff in the review of medical records (electronic and paper-based) - Serve as a final reviewer of HEDIS and QARR records