Lead Abstractor, HEDIS/Quality Improvement (Remote)

Job Description

Job Summary

Molina's Quality Improvement Lead Abstractor conducts data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The lead abstraction team will meet chart abstraction productivity standards, minimum over read standards, as well as working alongside their leadership team to mentor abstractors, lead projects and ensure project completeness.

Job Duties

• Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.
• Leads meetings with vendors for the medical record collection process.
• Assists Manager and Supervisor(s) in training, utilizing the standardized training materials and job aids.
• As needed, may collect medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
• Works with the National Over read team to monitor accuracy of abstracted records as required by specifications.
• Participates and leads scheduled meetings with the National Over read team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
• Mentor entry and Sr. level abstractors.
• Works with the Manager to monitor accuracy of abstracted records as required by specifications.
• Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
• Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.
• Provides data collection, presentations and report development support for quality improvement studies and performance improvement projects.
• Leads projects and process improvement initiatives.

Job Qualifications

REQU I RED ED U C A TI O N :

Bachelor's degree or equivalent experience

REQU I RED E X PE R I E N C E/KNOWLEDGE, SKILLS & ABILITIES:

• 5 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction
• Intermediate knowledge of HEDIS and NCQA

PR E FE R RED E X PE R I E N C E:

• 3 years of medical record abstraction experience
• 3 years managed care experience.
• Advanced knowledge of HEDIS and NCQA.

PR E FE R RED L I C E N S E, C E R TI FI C A T I O N , AS S O C I A TI O N :

Active RN license for the State(s) of employment

PHY S I C AL DEM A N D S :

W o rki n g en v i r o nm ent is g e n erally f a vo r a b le and li gh t i n g and t e m p erature are a d eq u at e . W o rk is g eneral l y p erf o r m ed in an o ff i ce e n v i r o n m ent in w h i c h t h ere is o n l y m i n i m al e x p o su r e to u np leasa n t a nd /o r ha z ar d o u s w o rki n g c o nd iti o n s. M u s t h a v e t h e a b ility t o s i t f o r l o n g p eri o d s. Rea s o n a b le acc om mo d a ti o n s m a y be m a d e to e n a b le in d i v i du als with d i sa b ilities t o p er f o r m t h e e ssential fu n cti o n .

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Info

Job Identification: 2029147

Job Category: Quality and Risk Adjustment

Posting Date: 2024-12-02T13:21:23 00:00

Job Schedule: Full time