Job Description

Job Description:

Job Tittle: Quality Improvement Abstractor

Location: Remote

Duration: 3 Months (Possible Extensions)

Shift: 8AM - 5Pm (Mon-Fri)

Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):

• Morning HEDIS huddle to discuss work assignments and address any concerns
• Review assigned workload chases
• Ensure all entries and documentation is entered in vendor system for chart chase
• Contact provider offices to inquire on charts not received
• Check portal for potential quality of care concerns
• Initiate chart audit and review if needed

Describe the performance expectations/metrics for this individual and their team:

• 40 pends reviewed and processed each day
• Completed audit of chart for potential quality of care

Tell me about what their first day looks like:

• Meet with Regina Everett Hiring Manager and Jeanette Walls HEDIS Project Manager to discuss the plan for the week and to ensure system accesses are requested

Must haves:

• Must assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards

• 4+ years of nursing, medical assistant, medical coding, or data management experience is required.

• Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) 2.

• Review medical records and abstract data for HEDIS and other measure sets in compliance with standards

• Track and report on issues and outcomes related to abstractions and over-reads

• Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required

• Perform other quality initiatives as necessary

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