Medical Records/Quality Control
QI Specialist I
3+ Months
Remote
PR:$37/hr
Job Description: 100% REMOTE BUT MUST RESIDE IN UTAH
Job Description:
- Essential Functions:
- Collects HEDIS data and/or Ambulatory Medical Record Review Data through chart review of medical records (medical record abstraction) as directed.
- Supports various HEDIS activities as needed.
- Reviews, identifies and trends quality of care issues, serious reportable adverse conditions and assists in the implementation of corrective action plans.
- Participates in the development of materials as needed for member and provider quality initiatives such as HEDIS, improvement projects, and studies.
- Knowledge/Skills/Abilities:
- Proficiency with PC-based systems
- Excellent verbal and written communication skills
- Ability to abide by Client’s policies
- Ability to maintain attendance to support required quality and quantity of work
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
- Required Experience:
- 0-2 years experience in Quality Improvement.
- 0-2 years experience in managed care or healthcare industry.
- Experience with qualitative or quantitative projects/analysis.
Required Licensure/Certification: None required. RN/LPN preferred
Must Have Skills:
- Knowledge/Skills/Abilities:
- Proficiency with PC-based systems
- Excellent verbal and written communication skills
- Ability to abide by Client’s policies
- Ability to maintain attendance to support required quality and quantity of work
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
- Day to Day Responsibilities:
- Contact providers to collect required medical records for RADV audit. May need to go to the clinic location to collect medical records.
- Work collaboratively with other Client departments to secure medical records for audits.
- Collaborates with the Quality Improvement department staff in the development of quality improvement studies, initiatives and projects to improve the health care of members.
- Plans and coordinates the collection, evaluation and dissemination of quality improvement data for quality initiatives, studies and projects to comply with regulatory requirements and accreditation standards.
- Prepares reports and analyses to evaluate performance with standards from a variety of sources such as and not limited to: materials, documents, medical charts, provider offices, and/or facilities.
- Performs with qualitative and quantitative analysis to identify significant and problematic clinical issues and concerns, development of improvement plans and measurement to assess impact of actions.
Job Type: Contract
Pay: $35.00 - $37.00 per hour
- Education:
- High school or equivalent (Preferred)
- Experience:
- Quality improvement: 5 years (Preferred)
- Healthcare Document Review : 5 years (Preferred)
- Providers data: 5 years (Preferred)
- NCQA: 5 years (Preferred)
- HIPAA: 5 years (Preferred)
- HEDIS: 5 years (Preferred)
- Medical records: 5 years (Preferred)
- Location:
- Utah (Required)
Work Location: Remote
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