POPULATION HEALTH COMPLIANCE TECHNICIAN

POSITION PURPOSE: Provides ongoing VBS/HEDIS medical record collection and abstraction; and supports the abstraction of medical records related to VBS/HEDIS Compliance initiatives. Provides accurate assessment of provider performance against VBS/HEDIS standards and procedures. Adheres to strict HIPAA confidentiality requirements for protected health information. Works under general supervision.

POSITION REQUIREMENTS / QUALIFICATIONS:

Education/Experience:  Graduate from a Standard High School or GED Equivalent.  Graduate from an approved Medical Coding Program, Medical Assisting program preferred.

Licensure / Certification:  Maintain current CPR certification from the American Heart Association. MA certification or coding certification desired    

Skills / Ability: Medical Terminology, Keyboard, Knowledge of Medicare, Medicaid, and Managed Care coverage benefits/limitations, NCQA HEDIS requirements. Knowledge of ICD9 and CPT Coding.  Basic computer knowledge is preferred. Bilingual in English/Spanish preferred.

POSITION RESPONSIBLITIES (THIS IS A NON-EXEMPT POSITION):

    Performing accurate and comprehensive reviews of medical records for HEDIS measures.

    Auditing high volumes of medical records to ensure correct and appropriate code assignment.

    Ability to multitask and troubleshoot problems independently.

    Ensuring accurate data entry for claim submission.

    Medical record review, data abstraction, and quality experience.

    Schedule appointments with health care provider including appointments to PCP for their health risk assessments, preventative visits and chronic care management.

    Participate in Performance Improvement Activities.

    Participate in appropriate continuing education in service training.

    Maintain current licensure and/or certificates.

    Ability to read and interpret medical documents.

    Ability to prioritize, multi-task, and achieve goals on time; work independently and to self-motivate.

    Strong data entry skills; capable of using a computer efficiently and effectively.

    Able to navigate and master practice management and EHR software programs.

    Treat clients, team members and the public with courtesy, respect and present a positive public image.

    High production environment and, candidates must adhere to measured productivity requirements.

    Ensuring adherence to NCQA HEDIS guidelines.

    Research medical history to determine the most appropriate and source of necessary documentation.

    Based on a strong knowledge of HEDIS criteria, identify the medical information that supports the specific HEDIS measure.

    Responsible for obtaining, organizing, and securing a large volume of medical records within a limited timeframe.

    Adhere to department Policies and Procedures in performing duties and assignments.

    Demonstrates the ability to work with a diverse population.

    Ability to post appropriate CPT Category II Performance Measure codes after chart review and audit.

    Reports to work on time and ready to work with minimal absenteeism.

    Adheres to Confidentiality Policies and Procedures / HIPAA Regulations.

    Well organized with the ability to maintain attention to detail.

    Ability to work independently and as a team member.

    Maintains productivity standard of reviewing 60 medical records daily.

    Performs other duties as assigned.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER