Responsible for assembling and maintaining patients' health information in medical records and charts..
Effectively review charts and gather information related to specific quality measures. Coordinate activities for assigned group under the supervision of an LPN/RN.
- Participate and coordinate all medical record audits and facilitate communication between the RN/LPN Practice Coordinators, practice staff and physicians.
- Facilitate resolution of any discrepancies found during an audit of the medical record and disease management program. Implement and maintain process for ongoing patient chronic disease identification. Communicate to the Health Plan clinical information needed for review and stratification of members for disease management t.
- Maintain process to gather information in the medical record and help to identify missing screenings for an office visit/point of care event.
- Document P4Q measure compliance in the data capture system (ASCENDER), validate claims, lab, and pharmacy data as well as face to face encounters for each member.
- Maintain an accuracy level of 95% on QA audits to be conducted a minimum of two times per year.
- Ensure any pertinent point of care information is communicated appropriately. After an office visit, send clinical information to the Health Plan and/or Practice Coordinator for member communication / calls.
- Maintain and update treatment alerts and flow sheets for the member within the medical record (paper or EMR) Utilize the data capture system (ASCENDER) to set ticklers and follow up for member appointments.
- Notify the enrollment and/or customer service department via the data capture system (ASCENDER) of any changes or anomalies in member record information.
- Develop and maintain processes that encourages all HealthSpring members to receive a minimum of one PCP visit per year.
- Coordinate with the Practice Coordinator to create and implement standing orders.
- Identify and implement process to identify members that are in need of preventive screening tests and issue correspondence to prompt physicians to complete measure.
- Provide feedback to practice physicians opportunities for process improvement.
- Identify and communicate social services needs of members to Health Plan for action.
- Participate and assist with HEDIS medical record audit data collection process as instructed by the Health Plan.
- Maintain current list of HealthSpring members to identify new patients and incorporate into existing P4Q activities.
- Collaborate with local Practice Coordinators regarding process improvement, communication efforts, barriers/challenges, and understanding of overall program processes.
- Participate in all operational meetings/calls as identified by the practice physicians and the Health Plan.
- Communicate with the Health Plan appropriately and provide positive and constructive feedback on an ongoing basis.(about what? .
- Assist the Health Plan with efforts related to proper coding, documentation, and data collection.
- Utilize the Health Plan data to identify members applicable to the coding process.
- Medical Assistant certification is required
- Communicates information accurately and timely to internal and external staff. Written and oral communication is accurate and effective and at the appropriate level.
- Ability to articulate information to personnel at all levels of understanding.
- Ability to handle multiple tasks, set priorities, and develop action items.
- Detail oriented.
- Works independently with a minimum amount of supervision, under the guidance of an RN/LPN.
- Word, Excel and Access experience preferred.
CIGNA - 12 months ago
With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...