What are the responsibilities and job description for the Sr. Overreader, HEDIS/Quality Improvement Abstractor (Remote) position at Molina Healthcare Group?
Job Description
Job Description
Job Summary
Molina's Quality Improvement Sr. Overreader conducts oversight and audits of the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The overreader team will meet chart overread productivity standards, minimum over read standards, and 2nd overread standards to ensure accuracy of their audit skills. Sr. Overread team members will mentor new overread team members and assist with ad hoc projects.
Job Duties
- Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project. Mentors entry-level Overreaders throughout the process.
- Provides feedback to providers on visit notes or feedback from the HEDIS audit. Makes recommendations based off of the audit and chart review.
- Assists with ad hoc projects.
- Participates in scheduled meetings with the Abstraction team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
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:
PR E FE R RED E X PE R I E N C E:
- At least 3 years of medical record abstraction experience and at least 2 years experience in the overread role.
- 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: 2030404
Job Category: Quality and Risk Adjustment
Posting Date: 2025-02-19T16:41:12 00:00
Job Schedule:
