Provides ongoing HEDIS/QARR/Risk Adjustment medical record collection and abstraction, along with records collection for Quality Management and Risk Adjustment initiatives. Responsible for clinical audits across products and for assessing provider performance against HEDIS/QARR standards and procedures.
The role works under general supervision and requires maintaining HIPAA confidentiality for protected health information.
What you will do
- Interact directly with provider offices, clinics, and other healthcare facilities to retrieve medical records for review and abstraction related to HEDIS/QARR/Risk Adjustment and other focused audits or studies.
- Schedule and perform onsite medical record reviews with high-volume providers.
- Manage and organize scanned medical records in a central repository, including data entry, scanning relevant record components, and applying proper naming conventions.
- Safeguard confidentiality of medical charts and records and comply with local, state, and federal medical records laws.
- Ensure HIPAA compliance for use, retrieval, storage, and sharing of medical records.
- Educate providers and office staff on HEDIS/QARR quality metrics, Risk Adjustment specifications, and medical record review criteria.
- Participate in training, quality improvement audits, Risk Adjustment Data Validation (RADV), and related surveys and studies.
- Maintain understanding of QM and Risk Adjustment policies and procedures to ensure compliance.
- Access scanned copies of medical records through vendor tools or client VPN directories.
- Follow up on outstanding issues identified during medical record review, including chart issue initiation and completion.
- Access EMRs to obtain pertinent information.
Requirements & Qualifications
Education
- Associate's degree in Nursing, Health Care Administration, RHIT, RHIA, Certified Coder, Allied Health, or another health-related field required.
Experience
- Minimum of 2 years of experience in medical record retrieval and review required.
- For quality management-only work, minimum of 1 year of quality improvement experience in Medicare, Medicaid, or commercial health plans required.
Skills and qualifications
- Knowledge of HEDIS/QARR standards and medical terminology.
- Strong computer and organizational skills.
- Ability to evaluate medical records with strong attention to detail.
- Ability to use databases and prepare reports.
- Ability to multitask and troubleshoot independently.
- Effective oral and written communication and interpersonal skills.
- Proficiency with Microsoft Windows, Word, PowerPoint, Excel, and Access.
Benefits & Perks
Benefits and perks
- Referral bonus opportunities
- Paid time off starting at 20 days plus 9 company holidays
- Medical, dental, vision, life, and disability insurance
- Employer-matched retirement savings
- Personal and financial wellness programs
- Pre-tax flexible spending accounts for healthcare and dependent care
- Tuition reimbursement for qualifying degrees
- Professional growth and career advancement opportunities
- Internal mobility and CEU credits
Location
New York, New York, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago