HEDIS Medical Record Review Specialist
Partnership HealthPlan of California - Fairfield, CA

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POSITION PURPOSE This is a temporary position. The assignment is from February to June 2014. To support Partnership HealthPlan’s efforts in collecting HEDIS performance data across all counties we serve (Solano, Napa, Yolo, Sonoma, Marin, and Mendocino). The HEDIS Medical Record Review Specialist will be responsible for the on-site data collection, data entry, and/or uploading of data abstracted from medical records. This position is accountable for obtaining, organizing, and securing a large volume of medical records within a limited time frame.

ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Collect, review, and abstract from medical records (in both electronic medical record systems and/or paper charts) to support reporting of HEDIS and STARS measures.
  • Perform accurate and comprehensive reviews of medical records timely, while maintaining appropriate HIPAA privacy and security standards.
  • Identify the medical information that supports the specific HEDIS measure.
  • Enter extracted data into designated software system.
  • Scan all medical record evidence supporting HEDIS measure using handheld scanning device and electronic file organization.
  • Maintain appointments scheduled with providers and clinics.
  • Work with the Quality Improvement HEDIS team to identify and share best practices and opportunities for improvement.
  • Participate in medical record inter-rater activities as required.
  • Report daily on Medical Record Review productivity.
  • Establish and maintain effective interpersonal relationships with all levels of staff, agencies, members, providers, and the general public.
  • Commitment to full contracted time throughout the HEDIS project (February to June).

HIRING CRITERIA

Education and Experience

Licensed LVN, RN, or RHIT certification required. Experience with HEDIS medical record reviews and knowledge of HEDIS measures is a plus.

Special Skills, Licenses and Certifications

Knowledge of general business office machine operations (i.e. handheld scanner, fax, copier, computer). Experience with Electronic Medical Records. Working knowledge of MS Office tools. Valid California driver's license.

Performance Based Competencies

Exceptional interpersonal skills to communicate with all levels of staff at provider sites. Excellent organization skills with ability to prioritize assignments and meet deadlines. Ability to use good judgment and to handle confidential and sensitive issues with tact and diplomacy. Excellent clinical skills. Must be able to work both with a team and independently.

Work Environment And Physical Demands

Ability to work within limited space accommodations, use a laptop and/or desktop computer equipment. More than 70% of work time is spent in front of a computer monitor. Must be able to lift, move, or carry objects of varying size, weighing up to 30 lbs. Must be able to operate a vehicle used for company business. Willing and able to drive within the health plan network service area (Solano, Napa, Yolo, Sonoma, Marin, and Mendocino Counties).

All HealthPlan employees are expected to:
  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

About this company
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PHC is a managed care organization that contracts with the State of California to ensure that Medi-Cal recipients in Solano, Yolo, Napa,...