Staff will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA guidelines and technical specifications.
• 7+ years experience
• High School Diploma or GED. Medical Assistant preferred.
• Customer service skills
• Data entry and/or typing experience.
• PC proficiency to include Word, Excel and Lotus Notes.
• Clear and concise written and verbal communication skills.
• Knowledge of medical terminology is helpful
Duties and Responsibilities:
• Obtain medical record data from PO Box and distribute to for scanning purposes.
• Scan in all paper documents obtained from the mail or fax. Identify member to the appropriate measure. Label documents as directed and place in appropriate measure file.
• Utilizes various software applications to support HEDIS operations by entering data or changing chase status pertaining to the medical records.
• Meets with HEDIS Coordinator and / or QI Specialists to discuss HEDIS efforts, any open issues and can include IRR results.
• Advise the appropriate staff person of their request incoming medical record data.
• May be directed to calls a provider office to follow-up on requested for medical records.
• Routes all complex issues to the Quality Improvement Specialists/HEDIS Coordinator.
• Maintains compliance with HIPAA and patient confidentiality requirements.
• All other duties as assigned.